Les leçons de lumières de Mlle de Lubert

« Faire durer une chose sans arriver au fait, afin de faire perdre de vue le but de l’entreprise » est une des définitions que prend le terme « amuser » à la fin du xviie siècle. En considérant l’amusement comme maître mot de son œuvre, Mlle de Lubert va tromper l’esprit du lecteur. Pris au piège de la légèreté du genre, il est contraint, sans s’en apercevoir, de renouveler sa réflexion politique. Rois poltrons ou dirigeants tyranniques vont être détrônés par le ridicule et le monstrueux que soutient la féerie. Sous la satire merveilleuse, la cour devient un microcosme mortifère, et la critique s’étend même jusqu’au sein des salons précieux. L’auteur nous demande maintes fois d’observer l’Histoire pour en retenir la leçon. Elle provoque chez ses personnages des attitudes philosophiques d’inspiration cosmopolite : l’un va devoir effectuer un Grand Tour, l’une assiste à un débat sur la notion d’étranger, une autre encore se rend compte de la nécessité de séparer les pouvoirs. Forte des leçons de politique qu’elle transmet par ses contes, Mlle de Lubert rend la féerie utile à la philosophie. Qui se méfie d’un conte de fées ? On y peut tout dire. Alors, quand l’utopie redouble la force du conte, la satire religieuse approfondit la leçon politique. L’indifférence sexuelle prend ainsi des airs de scepticisme théologique. Une esthétique du bizarre vient perturber une simple lecture des contes de Mlle de Lubert, remettant en question le pouvoir arbitraire d’une religion qui obscurcit les esprits. Car le démantèlement de la monarchie absolue ne se fait pas sans égratigner un Dieu tout puissant et misogyne. Et si la différence entre Dieu et la Fée était simplement une différence de sexe, l’un et l’autre fruits d’une imagination débridée ?Lessons of the Enlightenment by Mlle de Lubert. “To make a thing last without arriving at the fact, in order to make one forget its real object” is one of the definitions of the verb amuser at the end of the 17th century. Taking the amusement as the master word of her fairy work, Mlle de Lubert will mislead the spirit of the reader. He’ll fall into the trap of the flightiness of the tale, and will unconsciously revive his political meaning. The fairyhood will dethrone coward kings or despot monarchs giving them ridiculous and monstruous features. Under the satire, the court becomes an empty world, and a vain microcosm, while criticism extends all the way to the salons précieux. The author asks us many times to observe and retain the lessons that History gives. Amongst her characters, we’ll note philosophical attitudes to cosmopolitism: one of them will have to carry out a Grand Tour, one attends a discussion about foreigners, another still realizes the benefit of the separation of powers. Empowered by the lessons of policy which are transmitted by her tales, Mlle de Lubert makes fairyhood useful for the new philosophy of the Enlightenment. Who’ll be suspicious of a fairy tale? There one can say everything! Then, when utopia reinforces the tale, religious satire deepens the political lesson. Thus, sexual indifference takes airs of theological scepticism. An aesthetics of bizarre comes to disturb a simple reading of the tales, calling into question the arbitrary power of religion. Actually the dismantling of the absolute monarchy throws off balance the powerful and misogynous God. And if the difference between God and the Fairy were simply a difference in sex, both being the fruit of an unslung imagination

Effect of the COVID-19 pandemic on the psychotropic drug consumption

International audienceImportance Although the COVID-19 pandemic has had a negative impact on mental health, there is no comprehensive longitudinal study of the entire population of a country without selection bias. Objective The objective of this study was to evaluate the prescription of psychotropic drugs during the COVID-19 pandemic, using data from the French national health data system (SNDS). Design, settings, and participants Prescriptions for psychotropic drugs (antidepressants, anxiolytics, hypnotics, and antipsychotics) from 1 January 2015 to 30 September 2021 were collected from administrative data provided by the SNDS. This database includes more than 99% of the French population, i.e., 67 million people. The data were analyzed using an interrupted time series analysis (ITSA) model. Main outcomes and measures Consumption of psychotropic drugs was aggregated in months and expressed in number of boxes per thousand inhabitants. Results During the study period, more than 1.3 billion boxes of psychotropic medications were dispensed. Comparison of psychotropic drug dispensing before and after the pandemic showed a relative increase of 0.76 (95 CI 0.57 to 0.95, p <0.001) boxes per month per thousand inhabitants, all classes of psychotropic drugs combined. Three classes saw their consumption increase in an almost similar proportion, respectively, by 0.23 (0.15 to 0.32, p <0.001) boxes for antidepressants, 0.27 (0.20 to 0.34, p <0.001) boxes for anxiolytics and 0.23 (0.17 to 0.30, p <0.001) boxes for hypnotics. The change in antipsychotic consumption was very small, with an increase of 0.04 boxes (0.02 to 0.06, p = 0.001) per month per thousand population. Conclusion and relevance The COVID-19 pandemic had led to an increase in the consumption of psychotropic drugs, confirming the significant impact of the pandemic on the mental health of the general population

CANABIC: CANnabis and Adolescents: effect of a Brief Intervention on their Consumption - study protocol for a randomized controlled trial.

International audienceBACKGROUND: Cannabis is the most consumed illegal substance in France. General practitioners (GPs) are the health professionals who are most consulted by adolescents. Brief intervention (BI) is a promising care initiative for the consumption of cannabis, and could be a tool for GPs in caring for adolescents who consume cannabis. The aim of the CANABIC study is to measure the impact of a BI carried out by a GP on the consumption of cannabis by adolescents of 15 to 25 years of age. METHODS: A randomized clustered controlled trial, stratified over three areas (Auvergne, Languedoc-Roussillon, and Rhone-Alps), comparing an intervention group, which carries out the BI in consultation, and a control group, which ensures routine medical care. The main assessment criterion is the consumption of cannabis by amount of joints per month, at 12 months. The amount necessary to highlight a significant difference between the two groups of 30 % of consumption at 12 months is 250 patients (50 GPs, 5 patients per GP; risk alpha = 5 %; power = 90 %; intra-cluster correlation coefficient rho = 0.2; Hawthorne effect = 15 %; lost to follow-up rates for GPs = 10 % and for patients = 20 %). This plan is replicated for the three areas, and therefore a total of 750 patients are expected.The secondary criteria for judgment are the associated consumption of tobacco and alcohol, the perception of the consequences of consumption, and the driving of a vehicle following consumption. DISCUSSION: Research about BI for young cannabis users is underway. The aim of the CANABIC study is to validate a BI suited to adolescents who consume cannabis, which may be performed in the general practice. This would provide a tool for their treatment by a GP, which could be widely distributed during initial or further medical training.Trial registration: CANABIC is a randomized clustered trial (NCT01433692, registered 2011 Sept 12), PHRC funded: Clinical Research Hospital Program (Governmental Fund, Health Ministry). Date first patient randomized: March 2012

Health Care Support Issues for Internationally Adopted Children: A Qualitative Approach to the Needs and Expectations of Families

International audienceBACKGROUND: Families of internationally adopted children may face specific problems with which general practitioners (GPs) may not be familiar. The aim of the study was to explore problems faced by families before, during and after the arrival of their internationally adopted child and to assess the usefulness of a specific medical structure for internationally adopted children, which could be a resource for the GP. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a qualitative study using individual semistructured guided conversations and interviewed 21 families that had adopted a total of 26 children internationally in the Puy de Dome department, France, in 2003. Quantitative data were used to describe the pathologies diagnosed and the investigations performed.Our study showed that the history of these families, from the start of the adoption project to its achievement, is complex and warrants careful analysis. Health-care providers should not only consider the medical aspects of adoption, but should also be interested in the histories of these families, which may play a role in the forming of attachments between the adoptee and their adoptive parents and prevent further trouble during the development of the child. We also showed that adoptive parents have similar fears or transient difficulties that may be resolved quickly by listening and reassurance. Most such families would support the existence of a specific medical structure for internationally adopted children, which could be a resource for the general practitioner. However, the health-care providers interviewed were divided on the subject and expressed their fear that a special consultation could be stigmatizing to children and families. CONCLUSIONS/SIGNIFICANCE: A specific consultation with well-trained and experienced practitioners acting in close collaboration with GPs and paediatricians may be of help in better understanding and supporting adopted children and their families

Noyau spermatique humatin et fertilité

In humans, the success of fertilization and embryonic development leading to the birth of ahealthy child lies mainly in the quality of reproductive cells. Oxidative damage to sperm DNAis a major cause of male infertility. In order to provide optimal and appropriate therapeuticmanagement, I first developed and validated a diagnostic test for sperm DNA oxidation byimmunodetection of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a major adduct of nuclearoxidation. This thesis work determined, for the first time, a threshold for the oxidation ofsperm DNA in relation to conventional sperm parameters. In a second step, I focused on themost common chromatin and sperm DNA disorders in male infertility, namely chromatincondensation anomalies, sperm DNA fragmentation and oxidation. A correlation betweenDNA oxidation, particularly the mean fluorescence intensity, and the percentage offragmented sperm was found. To objectify the impact of this nuclear sperm damage inclinical practice, I studied, after cryopreservation, the beneficial effects of hypotaurinesupplementation to the selection and freeze/thaw media of seed samples. A decrease incryocapacitation and the percentage of fragmented and decondensed sperm has beenfound, as well as an improvement in sperm vitality and progressive mobility. Finally, sincethe ultimate goal of the sperm cells is to participate in the genesis of a new individual, I haveshown that the fragmentation and oxidation of sperm DNA has an impact at key moments inthe kinetics of early embryonic development following ICSI without modifying the obtainingof good quality blastocysts. This thesis work has led to a better understanding of thepathophysiology of male infertility and the identification of new sperm biomarkers related tonormal embryonic development.Chez l’Homme, les succès de la fécondation et d’un développement embryonnaire aboutissant à la naissance d’un enfant en bonne santé résident principalement dans la qualité des cellules reproductrices. Les dommages oxydants de l’ADN spermatique sont une cause majeure d’infertilité masculine. Afin de permettre une prise en charge thérapeutique optimale et adaptée, j’ai tout d’abord mis au point et validé un test diagnostique de l’oxydation de l’ADN spermatique par immunodétection du 8-hydroxy-2'-desoxyguanosine (8-OHdG), adduit majeur de l'oxydation nucléaire. Ce travail de thèse a déterminé, pour la première fois, un seuil d’oxydation de l’ADN spermatique en relation avec les paramètres conventionnels spermatiques. Dans un second temps, je me suis focalisée sur les atteintes de la chromatine et de l’ADN spermatique les plus fréquentes en cas d’infertilité masculine, à savoir les anomalies de condensation de la chromatine, la fragmentation et l’oxydation de l’ADN spermatique. Une corrélation entre l’oxydation de l’ADN, tout particulièrement la moyenne d’intensité de fluorescence, et le pourcentage de spermatozoïde fragmenté a été mise en évidence. Pour objectiver l’impact de ces dommages nucléaires spermatiques en pratique clinique, j’ai étudié, après cryopréservation, les effets bénéfiques d’une supplémentation en hypotaurine des milieux de sélection et de congélation/décongélation des échantillons. Une baisse de la cryocapacitation et du pourcentage de spermatozoïde fragmenté et décondensé ont été retrouvées ainsi qu’une amélioration de la vitalité et de la mobilité progressive spermatique. Enfin, comme le spermatozoïde a pour but ultime de participer à la genèse d’un nouvel individu, j’ai mis en évidence que la fragmentation et l’oxydation de l’ADN spermatique avaient un impact à des moments clés de la cinétique du développement embryonnaire précoce suite à une ICSI sans pour autant modifier l’obtention de blastocystes de bonne qualité. Ce travail de thèse a permis de mieux comprendre la physiopathologie de l’infertilité masculine et de mettre en évidence de nouveaux biomarqueurs spermatiques en lien avec un développement embryonnaire normal

Human sperm nucleus and fertility

Chez l’Homme, les succès de la fécondation et d’un développement embryonnaire aboutissant à la naissance d’un enfant en bonne santé résident principalement dans la qualité des cellules reproductrices. Les dommages oxydants de l’ADN spermatique sont une cause majeure d’infertilité masculine. Afin de permettre une prise en charge thérapeutique optimale et adaptée, j’ai tout d’abord mis au point et validé un test diagnostique de l’oxydation de l’ADN spermatique par immunodétection du 8-hydroxy-2'-desoxyguanosine (8-OHdG), adduit majeur de l'oxydation nucléaire. Ce travail de thèse a déterminé, pour la première fois, un seuil d’oxydation de l’ADN spermatique en relation avec les paramètres conventionnels spermatiques. Dans un second temps, je me suis focalisée sur les atteintes de la chromatine et de l’ADN spermatique les plus fréquentes en cas d’infertilité masculine, à savoir les anomalies de condensation de la chromatine, la fragmentation et l’oxydation de l’ADN spermatique. Une corrélation entre l’oxydation de l’ADN, tout particulièrement la moyenne d’intensité de fluorescence, et le pourcentage de spermatozoïde fragmenté a été mise en évidence. Pour objectiver l’impact de ces dommages nucléaires spermatiques en pratique clinique, j’ai étudié, après cryopréservation, les effets bénéfiques d’une supplémentation en hypotaurine des milieux de sélection et de congélation/décongélation des échantillons. Une baisse de la cryocapacitation et du pourcentage de spermatozoïde fragmenté et décondensé ont été retrouvées ainsi qu’une amélioration de la vitalité et de la mobilité progressive spermatique. Enfin, comme le spermatozoïde a pour but ultime de participer à la genèse d’un nouvel individu, j’ai mis en évidence que la fragmentation et l’oxydation de l’ADN spermatique avaient un impact à des moments clés de la cinétique du développement embryonnaire précoce suite à une ICSI sans pour autant modifier l’obtention de blastocystes de bonne qualité. Ce travail de thèse a permis de mieux comprendre la physiopathologie de l’infertilité masculine et de mettre en évidence de nouveaux biomarqueurs spermatiques en lien avec un développement embryonnaire normal.In humans, the success of fertilization and embryonic development leading to the birth of ahealthy child lies mainly in the quality of reproductive cells. Oxidative damage to sperm DNAis a major cause of male infertility. In order to provide optimal and appropriate therapeuticmanagement, I first developed and validated a diagnostic test for sperm DNA oxidation byimmunodetection of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a major adduct of nuclearoxidation. This thesis work determined, for the first time, a threshold for the oxidation ofsperm DNA in relation to conventional sperm parameters. In a second step, I focused on themost common chromatin and sperm DNA disorders in male infertility, namely chromatincondensation anomalies, sperm DNA fragmentation and oxidation. A correlation betweenDNA oxidation, particularly the mean fluorescence intensity, and the percentage offragmented sperm was found. To objectify the impact of this nuclear sperm damage inclinical practice, I studied, after cryopreservation, the beneficial effects of hypotaurinesupplementation to the selection and freeze/thaw media of seed samples. A decrease incryocapacitation and the percentage of fragmented and decondensed sperm has beenfound, as well as an improvement in sperm vitality and progressive mobility. Finally, sincethe ultimate goal of the sperm cells is to participate in the genesis of a new individual, I haveshown that the fragmentation and oxidation of sperm DNA has an impact at key moments inthe kinetics of early embryonic development following ICSI without modifying the obtainingof good quality blastocysts. This thesis work has led to a better understanding of thepathophysiology of male infertility and the identification of new sperm biomarkers related tonormal embryonic development