Prévention de l’adhésion aux gangs de rue : l’expérience des jeunes participants

La présente étude s’intéresse à la prévention de l’adhésion des jeunes aux gangs de rues dans les quartiers de Saint Michel et LaSalle. Plus précisément, est effectuée l’évaluation qualitative d’un programme d’intervention implanté dans deux sites différents soit SORACOM (Saint-Michel) et LaSalle-Wrap (LaSalle). Le mémoire s’inscrit dans une évaluation plus large du programme, financée par le Ministère de la Sécurité Publique Canada (CNPC), qui a débuté en 2013 et qui devrait se terminer en 2018. L’approche sur laquelle est fondé le programme est inspirée d’autres expériences WrapAround canadiennes (Debicki, 2009). L’analyse du protocole d’évaluation préparé par Lafortune et ses collègues (2015a ; 2015b) a permis de cibler une de ses limites, à savoir que l’expérience du programme et ses effets perçus sur le niveau de risque des jeunes participants à adhérer à un gang de rue n’est pratiquement pas pris en considération. Afin de dépasser cette limite, notre objectif de recherche se formule comme suit : comprendre et documenter l’expérience de la participation aux programmes LaSalle- Wrap et SORACOM chez les jeunes garçons à risque moyen ou élevé d’adhésion à un gang de rue. L’analyse prévoit décrire la motivation des jeunes à participer au projet; recueillir leur perception du projet et du processus que leur participation implique; comprendre le ou les liens entre le choix du projet développé par les participants, les besoins susceptibles d’être comblés par l’adhésion à un gang de rue et l’évolution du niveau de risque d’adhésion; et documenter les impacts perçus par les jeunes suite à leur participation au projet, et ce dans différentes sphères de leurs vies. Pour y parvenir, une approche qualitative a été préconisée. Quinze entrevues semi- structurées ont été effectuées auprès de jeunes participants afin de recueillir leur perception de l’impact de la démarche sur leur motivation à adhérer à un gang. L’analyse des résultats a permis d’identifier les nombreuses différences que les jeunes perçoivent entre le contexte et l’approche préconisée par les projets en comparaison à d’autres types d’intervention. Celles-ci sont pour eux une source de motivation à persévérer, particulièrement la relation qu’ils développent avec leur facilitateur WrapAround. L’évolution du niveau de risque d’adhésion à un gang de rue au cours du processus s’explique par divers facteurs. Notamment, la prise en considération des besoins identifiés par le jeune lors de la planification WrapAround et le développement d’outils personnalisés qui lui permettent d’entamer un processus de changement et ainsi de diminuer les facteurs de risque qu’il présente en travaillant sur ses facteurs de protection et ceux de sa famille.The interest of this study is street gang affiliation prevention in LaSalle and Saint- Michel neighborhoods. More precisely, we perform the qualitative evaluation of a intervention program implanted in two different sites; SORACOM (Saint-Michel) and LaSalle-Wrap (LaSalle). The thesis is part of a broader evaluation of the program that began in 2013 and which should be completed by 2018. The study is funded by Public Safety Canada (CNPC). The approach on which the program is based is inspired by other Canadian WrapAround experiences (Debicki, 2009). The study of the evaluation protocol prepared by Lafortune and his collaborators (2015a; 2015b) allowed to target one of its limits, the lack of consideration for the experience of participation in the program and the perceived effects on the youths risk level of affiliation to a street gang. In order to answer this limit, our goal is to understand and document the experience of participation in the LaSalle-Wrap and SORACOM projects on young boys at medium or high risk of adhesion to a street gang. Our analysis aims to : describe youths' motivation to participate in the project; collect their perception of the project and the process it implies; understand the link(s) between the choice of the project developed by the participants, the needs likely to be filled by the affiliation to a street gang and the evolution of the affiliation risk level; and document the impacts seen by youths in several life spheres after their participation. In order to meet our goals, we opted for a qualitative approach. Fifteen semi-structured interviews were conducted with youths in order to obtain their perception of their experience’s impacts on their motivation to join a street gang. The analysis of our data allowed to identify some differences perceived by youths regarding the project's context and approach of intervention, compared to other intervention services they know, as a source of motivation to persevere, particularly the relationship they develop with their WrapAround facilitator. The evolution of the youth’s street gang affiliation risk level during the process can be explained by several factors. Among others, the consideration for the youths' needs during the WrapAround planning phase and the development of personalized tools allows the youth to begin a process of change and, therefore, decrease its risk factors by working the youth’s and his/her family’s protective factors

Clinical practice guidelines for BRCA1 and BRCA2 genetic testing

BRCA1 and BRCA2 gene pathogenic variants account for most hereditary breast cancer and are increasingly used to determine eligibility for PARP inhibitor (PARPi) therapy of BRCA-related cancer. Because issues of BRCA testing in clinical practice now overlap with both preventive and therapeutic management, updated and comprehensive practice guidelines for BRCA genotyping are needed. The integrative recommendations for BRCA testing presented here aim to (1) identify individuals who may benefit from genetic counselling and risk-reducing strategies; (2) update germline and tumour-testing indications for PARPi-approved therapies; (3) provide testing recommendations for personalised management of early and metastatic breast cancer; and (4) address the issues of rapid process and tumour analysis. An international group of experts, including geneticists, medical and surgical oncologists, pathologists, ethicists and patient representatives, was commissioned by the French Society of Predictive and Personalised Medicine (SFMPP). The group followed a methodology based on specific formal guidelines development, including (1) evaluating the likelihood of BRCAm from a combined systematic review of the literature, risk assessment models and expert quotations, and (2) therapeutic values of BRCAm status for PARPi therapy in BRCA-related cancer and for management of early and advanced breast cancer. These international guidelines may help clinicians comprehensively update and standardise BRCA testing practices

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Les travaux pratiques :comment innover ?

info:eu-repo/semantics/nonPublishe

Les vulnérabilités numériques

International audienceThe development of digital technologies raises many hopes, but the digital environment reinforces some vulnerabilities while at the same time creating new ones. To illustrate this point, this contribution addresses the case of vulnerabilities between online platforms and user companies as well as the vulnerability of the persons concerned by the processing of personal data. Finally, decision support tools or exclusively automated tools are not without questions regarding transparency.Le développement des technologies numériques suscite de nombreux espoirs, mais force est de constater que l’environnement numérique renforce certaines vulnérabilités tandis qu’il en fait naître de nouvelles. Pour illustrer ce propos, cette contribution aborde le cas des vulnérabilités entre plateformes en ligne et entreprises utilisatrices, ainsi que la vulnérabilité des personnes concernées par un traitement de données à caractère personnel. Enfin, les outils d’aide à la prise de décision ou exclusivement automatisées ne sont pas sans poser des questions en matière de transparence

International and EU legal frameworks of aviation security

Chapter 4 stresses the intrinsic international nature of air transport and travel and the consequent need to implement a common legal framework. The legal initiatives related to aviation security started to emerge in the 1960s as an answer to the first wave of hijackings and were substantiated in the Tokyo Convention in 1963. Subsequent terrorist related hijackings led to the Hague and Montreal Conventions. The consequent regulations were changed in the decade following the tragic events of September 11, 2001 by enhancing the security protocols within the aircrafts and at the airports. Such measures should be commensurate with the risks and should take into account cost-benefit ratio analyses. The chapter then considers the EU regulations for aviation security since the September 11 events. A further section of the chapter discusses the passenger name records that started as a commercial initiative and were converted to a security protocol since 2004

Association between polycyclic aromatic hydrocarbons (PAH) dietary exposure and mortality risk in the E3N cohort

International audienceMost studies have explored the adverse health effects of polycyclic aromatic hydrocarbons (PAH) occupational exposure. However, the general population is also exposed to PAH, mainly through the diet. The goal of the present study is thus to investigate the association between PAH dietary exposure and mortality risk in middle-aged women of the E3N (Étude Épidémiologique auprès de femmes de la mutuelle générale de l'Éducation Nationale) French prospective cohort.The study included 72,513 women, whom completed a validated semi-quantitative food frequency questionnaire on 208 food items in 1993. Food contamination levels were assessed using data provided by the Anses (French Agency for Food, Environmental and Occupational Health & Safety) in the framework of the French second total diet study. PAH dietary exposure was studied as the sum of four PAH (PAH4), namely benzo[a]pyrene (BaP), chrysene (CHR), benzo[a]anthracene (BaA) and benzo[b]fluoranthene (BbF). Cox proportional hazard models were used to estimate hazard ratios (HR) and their 95 % confidence intervals (CI) for the risk of all-cause mortality as well as all-cancer, specific cancer (separately from breast, lung/tracheal, and colorectal cancer), cardiovascular disease (CVD), and specific CVD (including only stroke and coronary heart disease) mortality.During follow-up (1993–2011), 4620 validated deaths were reported, of which 2726 due to cancer and 584 to CVD. The median PAH4 dietary intake was 66.1 ng/day. There was no significant association between PAH4 dietary intake and the risk of all-cause, all-cancer, breast cancer, colorectal cancer, all-CVD and stroke and coronary heart disease mortality. On the contrary, we observed a positive and statistically significant association between PAH4 dietary intake and lung/tracheal cancer mortality risk, with a stronger association among current smokers than among former smokers and never smokers.In this study, we observed an association between PAH dietary exposure and lung/tracheal cancer mortality risk, especially among current smokers

Transferrin saturation is independently associated with the severity of obstructive sleep apnea syndrome and hypoxia among obese subjects

International audienceIntroduction & aims - Obstructive sleep apnea syndrome (OSAS) is a frequent complication of obesity. Intermittent chronic hypoxia which frequently results from OSAS could modulate the systemic control of iron metabolism and alter serum iron parameters, especially among obese patients.Aims - to evaluate whether serum parameters of iron bioavailability and storage (primary), as well as age, waist circumference, arterial hypertension and tobacco use (secondary) are associated with OSAS severity and/or hypoxia. Methods - design: a single-center retrospective study with prospective data collection; inclusion criteria: consecutive patients referred for initial assessment for obesity underwent nocturnal respiratory polygraphy and iron status serum assessment within a 3-month period. The adjusted analyzes were performed using ANOVA and reported as adjusted means and 95% confidence interval (95% CI).Results - 13 men and 56 women were included. OSAS prevalence: 72% (n = 50). Ferritin (mean ± SD, 260 ± 276 vs. 111 ± 89 μg/l, p = 0.01) and transferrin saturation (31 ± 10 vs. 24 ± 9%, p = 0.002) were significantly higher in case of moderate/severe OSAS than in absent/mild OSAS, independently from gender and tobacco use. Serum iron (19.4 μg/l [CI95%, 16.5-22.3] vs. 16.2 μg/l ([14.1-18.2], p = 0.056) and transferrin saturation (31.5% [26.3-36.7]) vs. 25.3% [21.6-29.1], p = 0.043) were higher when time under oxygen saturation 15%. Age (mean ± SD, 51 ± 11 vs. 41 ± 12 yr, p = 0.001), waist circumference (136 ± 18 vs. 123 ± 12 cm, p = 0.003), arterial hypertension (59% (n = 13/22) vs. 23% (n = 11/47), p = 0.004) and tobacco use (64% (n = 14/22) vs. 32% (n = 15/47), p = 0.01) were significantly greater in moderate/severe OSAS than in absent/mild OSAS.Conclusions - Transferrin saturation was associated with OSAS severity and time under hypoxia. This suggests a relationship between OSAS-induced hypoxia and iron metabolism among obese patients

Erosión litoral y participación cuidadana en el Oeste de Francia

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Challenges of studying the dietary exposure to chemical mixtures: Example of the association with mortality risk in the E3N French prospective cohort

International audienceFood is contaminated by many chemicals which interact with each other, resulting in additive, synergistic or antagonistic effects. It is thus necessary to study the health effects of dietary exposure to chemical mixtures rather than single contaminants. We aimed to investigate the association between dietary exposure to chemical mixtures and mortality risk in the E3N French prospective cohort. We included 72,585 women from the E3N cohort who completed a food frequency questionnaire in 1993. From 197 chemicals, and using sparse non-negative matrix under-approximation (SNMU), we identified six main chemical mixtures to which these women were chronically exposed through the diet. We estimated the associations between dietary exposure to these mixtures and all-cause or cause-specific mortality using Cox proportional hazard models. During the follow-up (1993-2014), 6441 deaths occurred. We observed no association between dietary exposure to three mixtures and all-cause mortality, and a non-monotonic inverse association for the three other mixtures. These results could be explained by the fact that, despite the different dietary adjustment strategies tested, we did not fully succeed in excluding the residual confounding from the overall effect of the diet. We also questioned the number of chemicals to include in mixtures' studies, as a balance needs to be reached between including a large number of chemicals and the interpretability of the results. Integrating a priori knowledge, such as toxicological data, could lead to the identification of more parsimonious mixtures, thus to more interpretable results. Moreover, as the SNMU is a non-supervised method, which identifies the mixtures only on the basis of the correlations between the exposure variables, and not in relation to the outcome, it would be interesting to test supervised methods. Finally, further studies are needed to identify the most adequate approach to investigate the health effects of dietary exposure to chemical mixtures in observational studies