Information et accompagnement des parents de petits nourrissons (enquête auprès de parents à Montpellier et perspectives)

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Intégrer la méditation en éducation thérapeutique du patient : Enquête et réflexions

Introduction : La pratique de la méditation prend de l’ampleur dans la population générale et parmi les patients. L’ETP peut être un espace pour proposer cette pratique, mais ceci est mal documenté. Notre. Notre objectif est de recenser les pratiques méditatives en ETP sur un territoire et de les analyser afin de voir leurs conditions d’émergence et de développement. Méthode : Nous avons mené une enquête rétrospective quantitative à visée descriptive par auto-questionnaire en ligne auprès de 530 acteurs d’ETP (essentiellement des coordonnateurs de programme) en Occitanie et en PACA. Puis il a été proposé à 12 répondants de participer à un entretien compréhensif par téléphone. Résultats : 86 (16 %) personnes ont répondu au questionnaire en ligne, 33 (entre 6 % des personnes interrogées et 38 % des répondants) proposaient des pratiques méditatives en ETP. Parmi ces derniers, cela était proposé à l’hôpital comme en ville, pour différentes pathologies (principalement obésité), dans le cadre de programmes d’ETP (67 %) ou hors programme (33 %). Cinquante-cinq pour cent des équipes proposaient des pratiques méditatives dans des ateliers thématiques comme la gestion de l’alimentation, du stress ou des douleurs, 36 % lors d’un atelier dédié à la découverte de la méditation et 9 % offraient un programme de méditation de type Mindfulness-based-stress-reduction (MBSR). L’animation des séances était assurée par un intervenant en ETP expérimenté en méditation mais non formé à l’animation de la méditation (58 %), par un professionnel de l’équipe formé à cet accompagnement (27 %), ou par un prestataire extérieur formé (21 %). Les professionnels pensaient que cette offre était clairement bénéfique pour les patients. Discussion : Quel que soit le format pédagogique, la proposition de méditation en ETP peut s’inscrire dans diverses intentions éducatives. Dans le cadre d’un programme d’ETP, la proposition de méditation relève de la sensibilisation, et non de l’entraînement. Des formations courtes ou des DU en méditation en santé pourraient permettre à des intervenants en ETP de mener des séances de méditation. Des propositions sur les compétences à acquérir par les patients dans cette pratique et des points de vigilances dans l’organisation de séances de méditation sont présentées. Conclusion : La méditation, bien qu’encore peu proposée en ETP, peut être intégrée en ETP et semble profitable pour les patients et les soignants. D’autres études sur l’impact de cette offre éducative chez les patients sont nécessaires

Littératie en santé et population vulnérabilisée - Étude exploratoire en vue de la validation sociocognitive et sociolinguistique française du Health Literacy Questionnaire (HLQ)

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Factors of microinflammation in non-diabetic chronic kidney disease: a pilot study

International audienceThe relationships between digestive bacterial translocation, uremic toxins, oxidative stress and microinflammation in a population of chronic kidney disease (CKD) patients without metabolic nor inflammatory disease are unknown.Background The relationships between digestive bacterial translocation, uremic toxins, oxidative stress and microinflammation in a population of chronic kidney disease (CKD) patients without metabolic nor inflammatory disease are unknown. Methods Bacterial translocation, uremic toxins, oxidative stress, and inflammation were assessed by measuring plasma levels of 16S ribosomal DNA (16S rDNA), p-cresyl sulfate (PCS), indoxyl sulfate (IS), indole acetic acid (IAA), F2-isoprostanes, hsCRP and receptor I of TNF alpha (RITNF alpha) in patients without metabolic nor inflammatory disease. 44 patients with CKD from stage IIIB to V and 14 controls with normal kidney function were included from the nephrology outpatients. 11 patients under hemodialysis (HD) were also included. Correlations between each factor and microinflammation markers were studied. Results 16S rDNA levels were not increased in CKD patients compared to controls but were decreased in HD compared to non-HD stage V patients (4.7 (3.9-5.3) vs 8.6 (5.9-9.7) copies/mu l, p = 0.002). IS, PCS and IAA levels increased in HD compared to controls (106.3 (73.3-130.4) vs 3.17 (2.4-5.1) mu mol/l, p = 5 mg/l (p = 0.01, 0.04 and 0.001 respectively). 16S rDNA, F2-isoprostanes were not correlated to microinflammation markers in our study. Conclusions In CKD patients without any associated metabolic nor inflammatory disease, only PCS, IS, and urea were correlated with microinflammation. Bacterial translocation was decreased in patients under HD and was not correlated to microinflammation

Spatial Variations in Crustal and Mantle Anisotropy Across the North American-Caribbean Boundary on Haiti

International audienceHaiti, on the island of Hispaniola, is situated across the North American-Caribbean plate boundary at the transition point between oblique subduction in the east and a transform plate boundary in the west. Here we use shear wave splitting measurements from S waves of local (0-50 km) and intermediate depth (50-150 km) earthquakes as well as SK(K)S phases from teleseismic earthquakes to ascertain good spatial and vertical resolution of the azimuthal anisotropic structure. This allows us to place new constraints on the pattern of deformation in the crust and mantle beneath this transitional region. SK(K)S results are dominated by plate boundary parallel (E-W) fast directions with~1.9 s delay times, indicating subslab trench parallel mantle flow is continuing westward along the plate boundary. Intermediate depth earthquakes originating within the subducting North American plate show a mean fast polarization direction of 065°and delay time of 0.46 s, subparallel to the relative plate motion between the Caribbean and North American plates (070°). We suggest a basal shear zone within the lower ductile crust and upper lithospheric mantle as being a potential major source of anisotropy above the subducting slab. Upper crustal anisotropy is isolated using shear wave splitting measurements on local seismicity, which show consistent delay times on the order of 0.2 s. The fast polarization directions indicate that the crustal anisotropy is controlled by the fault networks in close proximity to the major strike-slip faults, which bisect the north and south of Haiti, and by the regional stress field where faulting is less pervasive

The tectonics and active faulting of Haiti from seismicity and tomography

Oblique convergence of the Caribbean and North American plates has partitioned strain across a major transpressional fault system that bisects the island of Hispaniola. The devastating MW 7.0, 2010 earthquake that struck southern Haiti, rupturing an unknown fault, highlighted our limited understanding of regional fault segmentation and its link to plate boundary deformation. Here we assess seismic activity and fault structures across Haiti using data from 33 broadband seismic stations deployed for 16‐months. We use travel‐time tomography to obtain relocated hypocenters and models of Vp and Vp/Vs crustal structure. Earthquake locations reveal two clusters of seismic activity. The first corresponds to aftershocks of the 2010 earthquake and delineates faults associated with that rupture. The second cluster shows shallow activity north of Lake Enriquillo (Dominican Republic), interpreted to have occurred on a north‐dipping thrust fault. Crustal seismic velocities show a narrow low‐velocity region with an increased Vp/Vs ratio (1.80‐1.85) dipping underneath the Massif de la Selle, which coincides with a southward‐dipping zone of hypocenters to a depth of 20 km beneath southern Haiti. Our observations of seismicity and crustal structure in southern Haiti suggests a transition in the Enriquillo fault system from a near vertical strike‐slip fault along the Southern Peninsula to a southward‐dipping oblique‐slip fault along the southern border of the Cul‐de‐Sac‐Enriquillo basin. This result, consistent with recent geodetic results but at odds with the classical seismotectonic interpretation of the Enriquillo fault system, is an important constraint in our understanding of regional seismic hazard

Identification of distinct immune activation profiles in adult humans

International audienceLatent infectious agents, microbial translocation, some metabolites and immune cell subpopulations, as well as senescence modulate the level and quality of activation of our immune system. Here, we tested whether various in vivo immune activation profiles may be distinguished in a general population. We measured 43 markers of immune activation by 8-color flow cytometry and ELISA in 150 adults, and performed a double hierarchical clustering of biomarkers and volunteers. We identified five different immune activation profiles. Profile 1 had a high proportion of naïve T cells. By contrast, Profiles 2 and 3 had an elevated percentage of terminally differentiated and of senescent CD4+ T cells and CD8+ T cells, respectively. The fourth profile was characterized by NK cell activation, and the last profile, Profile 5, by a high proportion of monocytes. In search for etiologic factors that could determine these profiles, we observed a high frequency of naïve Treg cells in Profile 1, contrasting with a tendency to a low percentage of Treg cells in Profiles 2 and 3. Moreover, Profile 5 tended to have a high level of 16s ribosomal DNA, a direct marker of microbial translocation. These data are compatible with a model in which specific causes, as the frequency of Treg or the level of microbial translocation, shape specific profiles of immune activation. It will be of interest to analyze whether some of these profiles drive preferentially some morbidities known to be fueled by immune activation, as insulin resistance, atherothrombosis or liver steatosis

Microbial Translocation Is Linked to a Specific Immune Activation Profile in HIV-1-Infected Adults With Suppressed Viremia

International audiencePersistent immune activation in virologically suppressed HIV-1 patients, which may be the consequence of various factors including microbial translocation, is a major cause of comorbidities. We have previously shown that different profiles of immune activation may be distinguished in virological responders. Here, we tested the hypothesis that a particular profile might be the consequence of microbial translocation. To this aim, we measured 64 soluble and cell surface markers of inflammation and CD4+ and CD8+ T-cell, B cell, monocyte, NK cell, and endothelial activation in 140 adults under efficient antiretroviral therapy, and classified patients and markers using a double hierarchical clustering analysis. We also measured the plasma levels of the microbial translocation markers bacterial DNA, lipopolysaccharide binding protein (LBP), intestinal-fatty acid binding protein, and soluble CD14. We identified five different immune activation profiles. Patients with an immune activation profile characterized by a high percentage of CD38+CD8+ T-cells and a high level of the endothelial activation marker soluble Thrombomodulin, presented with higher LBP mean (± SEM) concentrations (33.3 ± 1.7 vs. 28.7 ± 0.9 μg/mL, p = 0.025) than patients with other profiles. Our data are consistent with the hypothesis that the immune activation profiles we described are the result of different etiological factors. We propose a model, where particular causes of immune activation, as microbial translocation, drive particular immune activation profiles responsible for particular comorbidities