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La dystopie comme fiction d’alerte : une approche du récit proactif
No full textInternational audienceEn tant que fiction capable d'agentivité pragmatique, la dystopie gagne à être envisagée sous l'angle de l’alerte. L'analyse proposée dans cet article développe une approche poétique attentive aux cadres génériques, discursifs et énonciatifs, et s'appuie sur un corpus littéraire et médiatique allant du XIXe siècle à la production contemporaine, incluant romans, récits d’anticipation, séries, films et usages militants. Il apparaît que la dystopie ne relève ni de l’évasion ni de la simple spéculation, mais d’une fabulation vraisemblable fortement indexée sur le discours social de son temps, qui fonctionne par extrapolation et superposition avec le réel. Les fictions qui en résultent privilégient l’identification et la reconnaissance plutôt que la défamiliarisation. Elles programment des effets sur leurs publics en termes de mise en garde, de critique, de capacitation ou d’habituation. L'article analyse les dispositifs narratifs récurrents (enchâssement, narrateurs non fiables, stratégies d’accréditation) qui renforcent la plausibilité et l’efficience de ces fictions. Il propose une réception contextualisée des dystopies et une approche de leur capacité à orienter les représentations et les comportements collectifs, en tant que mise en garde plutôt que prophétie à valider factuellement
Au cœur de la pratique éducative : la question éthique du "prendre soin"
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Adolescent pregnancy in French Guiana: double trouble for young mothers and small vulnerable newborns
No full textInternational audienceObjectives: Adolescent pregnancies (AP), defined as pregnancies in girls aged 10-19 years, are associated with adverse maternal and neonatal outcomes. They are frequently reported among those with low economic status. French Guiana (FG) is a French overseas territory with important social inequalities in South America, marked by inequalities. Our study aimed to describe the sociodemographic characteristics and use of the healthcare system for AP in FG. Study design: Population based historical cohort. Methods: This study included all births in FG between 2013 and 2021. Data from each mother-newborn pair ≥22 weeks of gestation and/or weighing ≥500 g were analysed. AP were compared to non-AP. Results: 67,962 newborns were included. AP accounted for 8810 pregnancies (13.0 %), which was 10 times more than in France. Newborns from AP were more frequently transferred to neonatal care units when compared to those from non-AP (10.6 % vs 9.5 %, p < 10 -3 ). St-Laurent-du-Maroni hospital (western part of FG) was the main place of delivery for AP with 50.7 % of all AP delivering there. Two countries of origin of the mothers accounted for the majority of AP: FG (65.9 %) and Suriname (17.3 %) (p<10 -3 ). AP were more frequently associated with preterm birth (aOR = 1.09 [1.01-1.18]), small for gestational age newborns (aOR = 1.66 [1.55-1.78]) and lack of health insurance coverage at delivery (aOR = 1. 34[1.19-1.49]). Conclusions: AP in FG is a public health concern. Comprehensive prevention and care approaches are needed given the double burden faced by young mothers and their children.</div
Tourmentes anthropocéniques et communauté agissante : quelques caractéristiques en faveur de la vivifiance
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De l’attestation au dialogue. Dispositifs pour se comprendre et contribuer à une démocratie en santé
No full textInternational audienceThis article continues the reflection initiated following the first phase of research on the participation of directly involved stakeholders—patients, their relatives, and caregivers—in health-related research. The aim is to amplify their perspectives and experiential knowledge in order to contribute to the development of health democracy. The first phase of the research culminated in a filmed study day open to all, designed both to bring together diverse perspectives through roundtable discussions with other individuals engaged in promoting health democracy and to showcase excerpts from the first phase of research. These excerpts were presented as dramatized readings by two actresses to diversify the dissemination formats for the diverse audience expected.This article focuses on the second phase, which involves an action-research project with seven groups of university students specializing in social intervention and disability studies. The objective is to identify the discursive insights emerging from focus groups conducted after the students viewed video excerpts containing direct testimonies and dramatized readings of verbatim transcripts.Cet article poursuit la réflexion engagée à la suite du premier volet de recherche concernant la participation des acteurs directement concernés – les patients, leurs proches et les soignants – aux recherches autour des problématiques de santé afin qu’ils donnent à entendre leurs points de vue et leurs savoirs expérientiels en vue d’œuvrer à une démocratie en santé. Le premier volet de recherche a donné lieu à une journée d’étude filmée, ouverte à tous, conçue d’une part pour croiser, sous forme de tables rondes, les points de vue avec d’autres personnes concernées par cette visée de démocratie en santé ; d’autre part, pour faire entendre des extraits de verbatims du premier volet de recherche, sous forme de lectures théâtralisées par deux comédiennes afin de diversifier les supports de diffusion au vu de la diversité du public attendu. L’article se centre ici sur le second volet décliné en recherche-intervention auprès de sept groupes d’étudiants universitaires dans le champ de l’intervention sociale et du handicap afin de repérer ce que donnent à entendre, au niveau discursif, des focus groups faisant suite au visionnage d’extraits vidéo contenant des témoignages directs et des lectures théâtralisées de verbatims
Predicting type 2 diabetes from concurrent mental disorders: findings from a French cohort study
No full textInternational audienceObjectives The link between mental and metabolic disorders is understudied. Moreover, mental disorders are typically explored individually, despite high rates of comorbidity. This large prospective study investigated the association of four concurrent mental disorders with incident type 2 diabetes (T2D) in adults recruited from the general population. Methods Adults without prevalent diabetes enrolled in the French NutriNet-Sante cohort who had completed the trait anxiety subscale of the Spielberger State-Trait Anxiety Inventory (STAI-T 2013-2016), the Center for Epidemiologic Studies Depression Scale (CES-D 2013, 2015), the Sick-Control-One-Fat-Food scale (SCOFF 2014) and a sleep questionnaire (2014) were eligible for analysis. A working group of physicians defined incident T2D cases (occurring through March 2024), cross-referencing self-reported diagnosis or treatment with the national health insurance database. Multivariable PLS-Cox models were used to investigate the association between specific mental health profiles and T2D incidence. Results The study sample included 29,332 participants [75.0% women, mean age = 53.4 (13.8) years]. During a mean follow-up of 7.2 years, there were 430 (1.5%) incident T2D cases. The baseline prevalence of each mental health condition was higher among adults who developed T2D versus their diabetes-free counterparts. Two mental health profiles (or latent components) were identified, of which only one remained significantly associated with T2D risk in fully-adjusted analyses (HR = 1.13, 95% CI: 1.06-1.21, p < 0.001). That profile was underscored by concurrent trait anxiety, depressive symptoms and an eating disorder. Conclusions Given the growing prevalence of mental disorders and T2D in the general population, the results highlight the urgent need for prevention that addresses mental disorders before they lead to deleterious metabolic consequences. The findings likewise advance mental-physical multimorbidity research. Key messages • Comorbidity of mental health conditions is not uncommon in the general population. • Clusters of mental health conditions can predict incident type 2 diabetes in adults
Dette publique et stabilité financière, une question de soutenabilité ?: Le cas de la crise des fonds de pension au RU en 2022
No full textInternational audienceThis paper discusses the role of public debt in the financial system, and its implication for financial stability. To this effect, we look at the UK pension funds turmoil of September 2022, which was, so the story goes, caused by Liz Truss’ government “mini-budget” announcement of September 23, 2022. In taking a closer look, we show that financial instability arose not from excessive deficits, but from vulnerabilities in sovereign debt markets. Specifically, liability-driven investment (LDI) strategies employed by pension funds, which relied on repo financing of gilt inventories, precipitated a liquidity spiral when yields rose abruptly around the time of the announcement. This challenges both the prevailing description of the events of September and October 2022, and mainstream accounts of the link between public debt and financial instability, as both accounts insist on the role of unreasonable public deficits. Our analysis highlights the need to study this link through the lens of market practices rather than fiscal “fundamentals” alone
In Silico Clinical Trials in Drug Development: A Systematic Review
No full textInternational audienceIn the context of clinical research, computational models have received increasing attention over the past decades. In this systematic review, we aimed to provide an overview of the role of so-called in silico clinical trials (ISCTs) in medical applications. Exemplary for the broad field of clinical medicine, we focused on in silico (IS) methods applied in drug development, sometimes also referred to as model informed drug development (MIDD). We searched PubMed and ClinicalTrials.gov for published articles and registered clinical trials related to ISCTs. We identified 202 articles and 48 trials, and of these, 76 articles and 19 trials were directly linked to drug development. We extracted information from all 202 articles and 48 clinical trials and conducted a more detailed review of the methods used in the 76 articles that are connected to drug development. Regarding application, most articles and trials focused on cancer and imaging-related research while rare and pediatric diseases were only addressed in 14 articles and 5 trials, respectively. While some models were informed combining mechanistic knowledge with clinical or preclinical (in-vivo or in-vitro) data, the majority of models were fully data-driven, illustrating that clinical data is a crucial part in the process of generating synthetic data in ISCTs. Regarding reproducibility, a more detailed analysis revealed that only 24% (18 out of 76) of the articles provided an open-source implementation of the applied models, and in only 20% of the articles the generated synthetic data were publicly available. Despite the widely raised interest, we also found that it is still uncommon for ISCTs to be part of a registered clinical trial and their application is restricted to specific diseases leaving potential benefits of ISCTs not fully exploited
