Syndrome métabolique, diabète sucré et vulnérabilité: une approche "syndémique" de la maladie chronique [Metabolic syndrome, diabetes mellitus and vulnerability: a syndemic approach of chronic diseases].

The pandemic metabolic syndrome is generally attributed to our lifestyle. The current therapeutic strategies are centered on the behavioral changes and pharmacotherapy. A deeply analysis reveals the importance of the socio-cultural determinants with a "dose-responses effect according to the socio-economic level. The "syndemic" theory, which puts at the same level the socio-cultural environment, the behaviors and biomedecine, suggests a more holistic approach. This theory suggests introducing other partners of care, such cultural-mediators and welfare workers trained in the care, to have finally an approach centered on the roots of the causes. The healthcare networks centered on the management of the costs of health should not forget the socio-cultural dimension, unless wanting to select the good cases.

Recommandations de pratique clinique dans la schizophrénie: de la théorie à la mise en application = Clinical practice guidelines for the treatment of schizophrenia: from theory to practice

Dans le cadre d'une étude rétrospective au sein d'une unité de réhabilitation, nous avons cherché à examiner le degré de respect de recommandations de pratique clinique (RPC) abordant le traitement pharmacologique au long cours de la schizophrénie, par des médecins qui n'en ont qu'une connaissance indirecte. The Expert Consensus Guideline for the treatment of schizophrenia (ECGTS) a été retenu comme référence sur la base d'une comparaison avec cinq autres RPC principales. Sur un collectif de 20 patients, les recommandations de l'ECGTS sont totalement respectées dans 65 % des cas, partiellement respectées dans 10 % et non respectées dans 25 %, démontrant ainsi que la pratique clinique est clairement perfectible (principalement dans le traitement des symptômes psychotiques et dépressifs). Cependant, le respect des RPC ne garantit pas forcément la résolution de tous les problèmes cliniques rencontrés : 12 patients sur 20 présentent des effets secondaires à l'évaluation clinique et pour huit d'entre eux, les recommandations à ce niveau, sont respectées. Notre étude montre cependant que le choix et l'application d'une RPC ne sont pas simples. Les RPC actuelles donnent peu ou pas d'instruments de mesure, ni de critères précis pour évaluer les problèmes cliniques auxquels elles font référence. L'avenir appartient donc à des RPC qui proposent, outre les recommandations cliniques elles-mêmes, les moyens de leur vérification et de leur application sur le terrain.

Public sector rationing and private sector selection [paper accepted and forthcoming in Journal of Public Economic Theory]

We study the interaction between nonprice public rationing and prices in the private market. Under a limited budget, the public supplier uses a rationing policy. A private firm may supply the good to those consumers who are rationed by the public system. Consumers have different amounts of wealth, and costs of providing the good to them vary. We consider two regimes. First, the public supplier observes consumers' wealth information; second, the public supplier observes both wealth and cost information. The public supplier chooses a rationing policy, and, simultaneously, the private firm, observing only cost but not wealth information, chooses a pricing policy. In the first regime, there is a continuum of equilibria. The Pareto dominant equilibrium is a means-test equilibrium: poor consumers are supplied while rich consumers are rationed. Prices in the private market increase with the budget. In the second regime, there is a unique equilibrium. This exhibits a cost-effectiveness rationing rule; consumers are supplied if and only if their costbenefit ratios are low. Prices in the private market do not change with the budget. Equilibrium consumer utility is higher in the cost-effectiveness equilibrium than the means-test equilibrium [Authors]

Host specialist clownfishes are environmental niche generalists.

Why generalist and specialist species coexist in nature is a question that has interested evolutionary biologists for a long time. While the coexistence of specialists and generalists exploiting resources on a single ecological dimension has been theoretically and empirically explored, biological systems with multiple resource dimensions (e.g. trophic, ecological) are less well understood. Yet, such systems may provide an alternative to the classical theory of stable evolutionary coexistence of generalist and specialist species on a single resource dimension. We explore such systems and the potential trade-offs between different resource dimensions in clownfishes. All species of this iconic clade are obligate mutualists with sea anemones yet show interspecific variation in anemone host specificity. Moreover, clownfishes developed variable environmental specialization across their distribution. In this study, we test for the existence of a relationship between host-specificity (number of anemones associated with a clownfish species) and environmental-specificity (expressed as the size of the ecological niche breadth across climatic gradients). We find a negative correlation between host range and environmental specificities in temperature, salinity and pH, probably indicating a trade-off between both types of specialization forcing species to specialize only in a single direction. Trade-offs in a multi-dimensional resource space could be a novel way of explaining the coexistence of generalist and specialists.

Hemispheric asymmetry and theory of mind: Is there an association?

Introduction. In autism and schizophrenia attenuated/atypical functional hemispheric asymmetry and theory of mind impairments have been reported, suggesting common underlying neuroscientific correlates. We here investigated whether impaired theory of mind performance is associated with attenuated/atypical hemispheric asymmetry. An association may explain the co-occurrence of both dysfunctions in psychiatric populations. Methods. Healthy participants (n 129) performed a left hemisphere (lateralised lexical decision task) and right hemisphere (lateralised face decision task) dominant task as well as a visual cartoon task to assess theory of mind performance. Results. Linear regression analyses revealed inconsistent associations between theory of mind performance and functional hemisphere asymmetry: enhanced theory of mind performance was only associated with (1) faster right hemisphere language processing, and (2) reduced right hemisphere dominance for face processing (men only). Conclusions. The majority of non-significant findings suggest that theory of mind and functional hemispheric asymmetry are unrelated. Instead of ''overinterpreting'' the two significant results, discrepancies in the previous literature relating to the problem of the theory of mind concept, the variety of tasks, and the lack of normative data are discussed. We also suggest how future studies could explore a possible link between hemispheric asymmetry and theory of mind.

Dialogism and dialogicality in the study of the self

This article stems from the statement that dialogical approaches to a study of the self face a double challenge: that of developing a conception of the self that both avoids social reductionism and accounts for the stability of the self. In discussing this double challenge, we identify three much debated issues: (a) To what does the notion of "Alter" exactly refer? (b) How could we conceptualize the fact that Subject-Alter interactions are not only interpersonal but entail larger social entities, in particular institutions? (c)What importance should we attach to the materiality of objects? We discuss these three questions from two standpoints - that of linguistics and that of psychology - and illustrate our theoretical proposals with an analysis of an excerpt taken from a focus-group discussion. In conclusion, we argue that the dialogism of discourse provides us with some clues about the dialogicality of the mind, whereas the latter invites us to develop a theory showing the importance of interactions in the construction of the self, to pay more attention to the transpersonal dimension of the social, and to consider that the material world contributes to the construction of the self.

Douleurs chroniques chez les personnes âgées: dimensions psychologiques [Chronic pain in elderly people: psychosocial dimension].

Chronic pain in elderly people requires to take into account somatic co-morbidities as well as its psychosocial dimensions. Chronic pain often represents a distress signal addressed to the environment and the care providers. Psychological suffering or mood disorders can be presented in the form of somatic complaints often associated with functional impairments, sometimes severe. Therapeutic care has to address functionality through an image-enhancing approach aiming to summon the patients' resources. The treatment of a concomitant depressive state necessitates a true commitment from the therapist. Its benefits are documented in elderly patients. Analgesic treatment as a whole will seek in particular to restore feelings of self-esteem and help the patient recover a good quality of life.