1,721,041 research outputs found
Database Burnout Rouen and Paris Nanterre (France) n=1134
No full text<p>Burnout Data of 1134 university students in France </p>
Data base eating disorder and irritable bowel syndrom university students
No full text<p>eating disorder and irritable bowel syndrom among university students in Rouen (France)</p>
<p>Associated behaviors</p>
Epidemiological and bioclinical approach of eating disorders in children.
No full textLes troubles des conduites alimentaires (TCA) de l’adulte et de l’adolescent sont bien connus depuis les années 1980, mais il a fallu attendre les années 1990 pour que les troubles d’oralité (TO) et les TCA de l’enfant soient étudiés spécifiquement, et soient intégrés à la classification américaine des troubles mentaux (DSM-5) en 2013. Actuellement les professionnels de l’enfance connaissent bien les TCA de l’adolescent (essentiellement pris en charge par des pédopsychiatres), et les troubles d’oralité du nourrisson (pris en charge par des pédiatres), mais il semble que les TCA de l’enfant soient encore assez méconnus des professionnels de soins primaires et secondaires, et donc peu pris en charge. L’objectif de la thèse était donc dans un premier temps de faire une étude prospective non interventionnelle en population générale pour évaluer la prévalence et la prise en charge de ces troubles (étude PEDIANUT), puis dans un deuxième temps de faire une étude rétrospective d’une cohorte déjà constituée de TO-TCA (étude PEDIAFED).L’étude PEDIANUT, en utilisant la classification DSM-5 chez 401 enfants âgés de 0 à 18 ans interviewés avec leur famille, a permis de montrer que les Avoidant and Restrictive Food Intake Disorder (ARFID) et les Unspecified Feeding and Eating Disorders (UFED) sont probablement plus fréquents en pédiatrie que des TCA plus connus comme l’anorexie et la boulimie ; et qu’ils sont peu pris en charge. La prévalence des ARFID dans notre étude était ainsi de 3% [95%CI (1.7-5.1)], et celle des UFED de 9.7% [95%CI (7.2-13.0)]. Seuls 15.2% des enfants étaient pris en charge par un professionnel, alors que 87.8% des familles étaient inquiètes, ce qui suggère un manque de connaissances de ces troubles par les professionnels. Une étude ancillaire exploratoire de cette même cohorte a analysé les facteurs associés aux traits d’appétit de ces patients (profil normal, petit mangeur, gros mangeur, problématique ou non) : on retenait surtout comme associations peu décrites et étudiées dans la littérature le fait que les gros mangeurs problématiques étaient associés à la présence de troubles sensoriels, et que les petits mangeurs (1-6ans) étaient associés à un retard de langage (p<.05), ce qui peut constituer des pistes de recherche intéressantes.L’étude PEDIAFED a permis de comparer 2 cohortes de TO-TCA selon 2 recrutements gastropédiatrique (n=100) et pédopsychiatrique (n=91), chez 191 enfants âgés de moins de 12 ans. Cette cohorte comprenait 100 ARFID, 57 UFED, 33 anorexie mentale à début précoce (AMDP), 1 pica/ rumination. Les ARFID étaient associés aux troubles sélectifs et sensoriels ; et présentaient plus de troubles anxieux et de douleurs abdominales récurrentes que les UFED (p<.001). Les UFED avaient plus de maladies chroniques, refus des morceaux, troubles du langage (p<.05). Les AMDP étaient référées exclusivement aux psychiatres, étaient plus souvent dénutries, de sexe féminin, en dépression (p<.001). La cohorte de gastroentérologie comprenait plus d’UFED et de maladies chroniques, alors que celle de psychiatrie comprenait plus de comorbidités psychiatriques (p<.05). Les ARFID avaient une moins bonne évolution clinique (p<.001). Cette étude montrait que 25% des enfants avaient à la fois des comorbidités digestives et psychiatriques, ce qui suggère dans cette tranche d’âge la nécessité d’une approche pluridisciplinaire.Ainsi ces travaux montrent la nécessité de former les professionnels au dépistage des TCA de l’enfant. Il faudrait mieux définir les sous-types d’UFED, très fréquents en pédiatrie, et les FED en général selon les comorbidités associées (psychiatriques, maladies chroniques). Nous abordons également dans cette thèse des pistes de recherche (microbiote/ARFID) et essais thérapeutiques (cyproheptadine/ARFID). Une vision transdisciplinaire des FED permettra d’améliorer ces objectifs de recherche.Adult and adolescent Eating Disorders (ED) are well known since the 1980s, but it was not until the 1990s that Feeding Disorders (FD) and childhood ED were specifically studied and included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Currently, pediatric care professionals are familiar with adolescent ED (mainly managed by psychiatrists), and infant FD (managed by pediatricians), but it seems that child FED is still relatively unknown to primary and secondary care professionals, and therefore poorly managed. The aim of the thesis was therefore firstly to carry out a non-interventional prospective study in the general population to assess the prevalence and management of these disorders (PEDIANUT study), and secondly to carry out a retrospective study of a clinical cohort of FED (PEDIAFED study).The PEDIANUT study, using the DSM-5 classification in 401 children aged 0-18 years interviewed with their families, showed that Avoidant and Restrictive Food Intake Disorder (ARFID) and Unspecified Feeding and Eating Disorders (UFED) are probably more frequent in pediatrics than the better-known ED such as anorexia and bulimia nervosa; and that they are poorly managed. The prevalence of ARFID in our study was 3% [95%CI (1.7-5.1)], and that of UFED 9.7% [95%CI (7.2-13.0)]. Only 15.2% of children were under the care of a professional, while 87.8% of families expressed concern, suggesting a lack of knowledge of these disorders among professionals. An exploratory ancillary study of this same cohort analysed the factors associated with the appetite traits of these patients (normal profile, small or big eater profile, problematic or not): some associations poorly described in the literature were that problematic big eater profile was associated with the presence of sensory disorders, and that small eater profile (1-6 years old) were associated with language delay (p<.05), which may constitute interesting avenues for research.The PEDIAFED study compared 2 cohorts of FED according to 2 recruitments: gastroenterology unit (n=100) or psychiatry unit (n=91), in 191 children under 12 years of age. This cohort included 100 ARFID, 57 UFED, 33 early-onset anorexia nervosa (EOAN), 1 pica/rumination. ARFID was associated with selective and sensory disorders; and had more anxiety disorders and recurrent abdominal pain than UFEDs (p<.001). UFED patients had more FED related to chronic disease, refusal of pieces, language disorder (p<.05). EOAN patients were female, underweight, referred exclusively to the psychiatrist, and had more depression (p<.001). The gastroenterology cohort included more UFED, and FED related to chronic disease, while psychiatric comorbidities were more frequent in the psychiatry cohort (p<.05). ARFID was associated with a worse clinical outcome (p<.001). This study showed that 25% of the children had both digestive and psychiatric comorbidities, which suggests the need for a multidisciplinary approach in this age group.This work shows the need to train professionals in the screening of pediatric FED. The subtypes of UFED, which are very frequent in pediatrics, should be better defined, and all FED should be phenotyped according to associated comorbidities (psychiatric, chronic diseases). In this thesis we also address future research projects (microbiota/ARFID) and therapeutic trials (cyproheptadine/ARFID). A transdisciplinary view of FED will enhance these research objectives
Inhaled morphine titration in the emergency department : modernization of the severe pain management in adults
No full textNotre objectif était d’optimiser la prise en charge de la douleur aiguë sévère en médecine d’urgence. La titration morphinique intraveineuse qui fait actuellement référence doit se moderniser pour répondre aux nouveaux enjeux de la pratique en même temps que l’on doit garantir une balance bénéfice risque inchangée dans la lutte contre l’oligoanalgésie. Le travail décrit dans cette thèse, constitue une première étape d’évaluation d’une alternative nébulisée à la titration morphinique, à travers 3 études cliniques (AEROMORPH1, CLIN-AEROMORPH, EPIMORPH) et l’étude de son contexte dans la littérature. Des travaux chez le volontaire sain ont permis d’établir un mode opératoire avec une technique aérosol simple et accessible, de courte durée (5 min), que l’on peut répéter en titration (toutes les 10 min). Sa faisabilité est en voie d’être confirmée à grande échelle dans une étude multicentrique clinique et sa non-infériorité en termes d’efficacité est en cours d’évaluation. Des données pharmacologiques chez le volontaire sain et chez les patients confirment une concentration sanguine en morphine proche des concentrations efficaces observées en intraveineux (1 à 120 ng/ml dans CLIN-AEROMORPH), ce qui est déjà un résultat positif démontré par nos travaux. Par ailleurs, sur le plan de son éligibilité, nos données observationnelles et de simulation de décision, associées aux données médico-économiques que nous avons analysées dans la littérature, suggèrent la nécessité de baser son indication autrement que sur la simple évaluation par EVA/EN à l’accueil. Dans ce travail nous montrons que la pratique des praticiens témoigne aujourd’hui de leur manque d’adhésion au déclenchement systématique de la prescription d’opiacés Iv titrés par l’autoévaluation de la douleur sévère (de 6 à 20% de respect des critères SFMU, 61% de réinterprétation des scores EVA/EN). Si la titration aérosol est uniquement proposée en starter de la titration morphinique sans moderniser les algorithmes de décision de prescription opiacée dans les protocoles d’urgences, il est probable que cette nouvelle proposition thérapeutique ne résoudra qu’une partie de la problématique actuellement posée. Une prise en charge pharmacologique la plus individualisée possible est plus que jamais pertinente, avec une prescription ciblée de la titration morphinique selon la typologie du patient, en plus d’une priorisation par typologie douloureuse. En développant un « modèle douleur » original chez le volontaire sain, nous avons d’ailleurs mis en lumière des profils de patients « hyperesthésiques » et « endurants », sur le plan neurophysiologique et biochimique, qui sont sûrement retrouvés en pratique clinique quotidienne. L’ensemble de ces éléments doivent donc être pris en compte pour améliorer la prise en charge de la douleur en médecine d’urgence, avec une vision plus systémique, et davantage d’études dédiées, utilisant des méthodes d’évaluation innovantes mêlant critères quantitatifs robustes et qualitatifs exhaustifs.Our goal was to optimize the management of severe acute pain in emergency medicine. Intravenous morphine titration, which is currently the referent method, must be modernised to meet the new challenges of practice while at the same time, we must keep guaranteeing an unchanged risk-benefit balance in the fight against oligoanalgesia. Our work, described in this thesis, has been a cornerstone for the evaluation of a nebulized alternative solution to emergencies through 3 clinical studies, (AEROMORPH1, CLIN-AEROMORPH, EPIMORPH), and study of its contextualisation in literature. Work in healthy volunteers allowed us to establish a simple and accessible procedure for aerosol, of short duration (5 min), which can be repeated in titration procedures (every 10 min). Its feasibility is likely to be confirmed on our multicentre clinical study at a large scale and its efficacy, by a non-inferiority design of study is being evaluated. Pharmacological data in healthy volunteers and in patients confirm a blood morphine concentration close to the effective blood concentrations observed by intravenous administration (CLIN-AEROMORPH: 1-20 ng/ml), which is already a positive result demonstrated by our work. Moreover, regarding eligibility, our observational study, combined to a experiment about decision mechanisms, combined with the analysis of medico-economic data in literature, suggest the need to base its indication on more than just the simple VAS/NRS assessment at triage. In this work we showed that emergency practitioners’ practice today underlines their lack of adherence to the systematic initiation of intravenous morphine titration by patient self-assessment of severe pain (compliance with SFMU criteria 6 to 20%, re-assessment of VAS/NRS scores 61%). If nebulized morphine titration is only proposed as a starter for morphine titration without modernising the algorithms for opiate prescription decision in emergency protocols, it is likely that this new therapeutic proposal will only solve part of the current problem. Targeted pharmacological management, as individualised as possible, is more relevant than ever, with prescription of morphine titration according to the patient's typology, in addition to prioritisation by pain typology. By developing an original pain model in healthy volunteers, we have also highlighted profiles of "pain sensitive" and "enduring" patients, according to neurophysiological and biochemical data, that are certainly represented in daily clinical practice. Therefore, all these components should be taken into account to improve pain management in emergency medicine, with a more systemic vision and more dedicated studies using innovative evaluation methods, combining robust quantitative criteria with comprehensive qualitative criteria
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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