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International audience; Our objective was to quantify the impact on the use of zolpidem of the obligation implemented in France in 2017 to use secure prescription pads to prescribe it. We conducted a cohort study within the French SNDS healthcare database. Patients aged over 18 years of age were considered for inclusion. The number of prevalent users and incident episodes of zolpidem use were compared before the change in law (July 1, 2016 to January 1, 2017) and after (July 1, 2017 to January 1, 2018). A prevalent user was a patient who has been reimbursed for zolpidem at least once. An incident episode of zolpidem use was defined by a first administration of zolpidem without any prior administration within the previous six months. Regarding prevalence of zolpidem users, we observed a decrease from 2.79% (CI95%:2.75-2.83) to 1.48% (1.44-1.51), with a number of patients who stopped taking it after the change in law being approximately 4.3 times higher than the number of patients who started. We observed a negative association between the post-law change period (OR = 0.52 (0.51-0.53)) and the probability of receiving zolpidem, adjusting for sex, aging, low income and chronic disease. We observed a decrease from 183 treatment episodes per 100,000 insured months on average to 79 episodes per 100,000 insured months, with an incidence rate ratio (IRR) equal to 0.43 (0.38-0.49). The use of secure prescription pads seems to have reduced the exposure of the French population to zolpidem.

The representation of rodents’ mystacial vibrissae within the primary somatosensory (S1) cortex has become a major model for studying the cortical processing of tactile sensory information. However, upon vibrissal stimulation, tactile information first reaches S1 but also, almost simultaneously, the secondary somatosensory cortex (S2). To further understand the role of S2 in the processing of whisker inputs, it is essential to characterize the spatio-temporal properties of whisker-evoked response dynamics in this area. Here we describe the topography of the whiskers representation in the mouse S2 with voltage sensitive dye imaging. Analysis of the spatial properties of the early S2 responses induced by stimulating individually 22 to 24 whiskers revealed that they are spatially ordered in a mirror symmetric map with respect to S1 responses. Evoked signals in S2 and S1 are of similar amplitude and closely correlated at the single trial level. They confirm a short delay (~3 ms) between S1 and S2 early activation. In both S1 and S2 caudo-dorsal whiskers induce stronger responses than rostro-ventral ones. Finally, analysis of early C2-evoked responses indicates a faster activation of neighboring whisker representations in S2 relative to S1, probably due to the reduced size of the whisker map in S2.

International audience; Visuospatial attention has an inherent asymmetry: the leftward bias called pseudoneglect. In typical line bisection tasks, healthy individuals tend to judge the center of a line leftward of the true center, an effect attributed to the right hemisphere dominance in visuospatial attention. Since it has been shown that information perceived by the dominant eye strongly activates the ipsilateral visual cortex, we hypothesized that eye dominance may modulate visuospatial attention bias. Because activation of the left hemisphere induced by left eye dominance should mitigate the right hemisphere dominance in attention, we predicted that right-handed individuals with left dominant eye would show smaller amount of pseudoneglect than right-handed individuals with right dominant eye. We compared the performance at both the perceptual (Landmark) and manual line bisection task of forty right-handed healthy individuals, half of whom had a right dominant eye and the other half a left dominant eye. As predicted, the left eyed dominant group showed smaller, actually not significant pseudoneglect, which was thus greater in the right eye dominant group. The influence of eye dominance on visuospatial attention was present in the Landmark but not the manual line bisection task, in which the amount of visuospatial bias correlated with participants' degree of (right) handedness. This is the first report of the effect of eye dominance on visuospatial attention within a right-handed population. This finding, by showing the influence of eye dominance on visuospatial cognition, not only helps in better defining intact visuospatial cognition mechanism but also encourages further research to pinpoint the neural basis of such interaction.

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International audience; Contexte & ObjectifLa technique de porte-au-nez (Cialdini et al., 1975) consiste à obtenir un refus à une première demande trop coûteuse (requête extrême) dans le but de faciliter l’acceptation d’une seconde qui l’est moins (requête cible). Différentes interprétations théoriques ont été proposées (Feeley et al., 2012) sans qu’aucune d’entre elles ne fasse référence à un éventuel besoin de consistance. Cependant, selon l’hypothèse théorique que nous défendons, l’effet de porte-au-nez pourrait en partie s’expliquer par l’inconsistance entre la position des participants vis-à-vis de la cause présentée dans les requêtes et le comportement de refus de la requête extrême (Mauny & Sénémeaud, 2015; Sénémeaud et al., 2008). Dans cette logique, nous nous attendons à ce que l’activation d’une forte importance accordée à la cause augmente l’acceptation de la requête cible tandis que l’activation d’une faible inconsistance devrait la diminuer. Matériel & MéthodeCette hypothèse a été testée lors d’une étude réalisée en collaboration avec l’EFS auprès de 180 participants de l’Université de Caen-Normandie. Dans un premier temps, nous avons manipulé l’importance accordée au don de sang au travers d’un faux feed-back délivré à la suite d’un IAT. Ce faux résultat informait les participants que leurs résultats à l’IAT suggéraient qu’ils accordaient soit une forte importance au don de sang, soit une importance modérée, soit une importance faible. La prise en compte du faux résultat a été vérifiée par le remplissage d’une manip’check par les participants. Dans un deuxième temps, un expérimentateur différent demandait à la moitié des participants de s’engager à réaliser un don de plaquette tous les deux mois pendant un an (requête extrême). Après le refus de ces participants, il leur proposait de s’engager à réaliser un don de sang lors de la prochaine collecte de sang mobile (requête cible). Pour l’autre moitié des participants, l’expérimentateur formulait uniquement la requête cible.Résultats & DiscussionL’analyse par régression logistique met en évidence que plus le feed-back reçu renvoie à un niveau d’importance élevé, plus les participants acceptent la requête mais principalement après avoir refusé la requête extrême, Wald(1) = 3,69, p = .055, OR = 3,08 (95% IC 0,98-9,71). L’effet de cette technique n’est donc reproduit qu’en cas de forte incohérence avec le niveau d’importance activé, ce qui témoigne du rôle de l’inconsistance dans le paradigme de la porte-au-nez. Ce résultat sera discuté en faisant référence aux différents types d’inconsistance que nous retrouvons dans les paradigmes de dissonance cognitive.

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ObjectiveAdolescent migrants present psychological disorders more frequently than the corresponding host population but their access to care and to follow-up are less effective. The French method of transcultural psychotherapy (TPT) was conceived to respond to these problems. Our objective is to assess how these adolescents and their families perceive the experience and effectiveness of TPT.MethodWe conducted semistructured interviews with the families of adolescents seen for TPT. The data were analyzed by a qualitative thematic methodology.ResultsWe spoke to 21 participants in 8 families. The families came to TPT with a sense that the teen's current treatment was at an impasse. During the follow-up, they noted that family communication and relationships had improved, as had their connection to their culture of origin. Besides commenting on what they perceived as limitations, families identified specific elements of TPT as therapeutic.ConclusionThe pronounced diversity of the group and the use of both multiperspective narration and an interpreter were specific elements driving the construction of a good therapeutic alliance, despite the initial barriers. Pursuit of the evaluation of TPT is essential to advance the psychiatric care of adolescent migrants.

Biological aging is revealed by physical measures, e.g., DNA probes or brain scans. Individual differences in personal functioning are instead explained by psychological constructs.Constructs such as intelligence or neuroticism are typically assessed by specialized workforce through tailored questionnaires and tests. Similar to how brain age captures biological aging, intelligence and neuroticism may provide empirical proxies for mental health. Could the combination of brain imaging and sociodemographic information yield measures for these constructs that do not rely on human judgment? Here, we built proxy measures by applying machine learning on multimodal MR images and rich sociodemographic informationfrom the largest brain-imaging cohort to date: the UK Biobank. Objective comparisons revealed that all proxies captured the target constructs and related to health-contributing habits beyond the measures they were derived from. Our results demonstrate that proxies targeting classical psychological constructs reveal facets of mental health complementary to information conveyed by brain age.

Présentation Poster; International audience; In the 4-month-old infant brain, the visual categorization of natural face images is enhanced by concomitant maternal odor (Leleu et al., 2019), providing support for the early perception of congruent associations between co-occurring inputs from multiple senses. Here, we further explore whether this maternal odor effect is selective to faces or if it can be explained by a more general influence of salient odor cues on the perception of any visual object category. In Experiment 1, scalp electroencephalogram was recorded during a fast periodic visual stimulation (FPVS-EEG) while 4-month-old infants were exposed to the maternal vs. a control odor. In rapid 6-Hz streams of natural images (i.e., 6 stimuli per second), images of cars instead of faces were interspersed every 6th stimulus among other nonface objects (i.e., at 1 Hz). We isolated a neural categorization response to cars at the predefined 1-Hz frequency over the right occipital region in both odor contexts, showing the ability of infants to categorize variable exemplars of cars at a glance. However, maternal odor did not enhance this response, supporting its face-selective influence. In Experiment 2, images of nonface objects resembling faces (i.e., facelike stimuli) were used as the target category, i.e., interleaved every 6th image in the stream of stimulation. The brain response to facelike objects was faint yet clearly identifiable over bilateral occipito-temporal sites in the control odor condition, revealing infants' sensitivity to facelike patterns in a fast train of various categories of living and nonliving objects. More importantly, we observed that maternal odor magnified the facelike categorization response over the right hemisphere in a majority of infants, showing that this highly relevant odor triggers a face-selective neural activity even in the absence of genuine human faces. In both experiments, the general visual response elicited by the rapid 6-Hz stimulation was immune to the maternal odor effect, excluding any account in terms of an undifferentiated increase of visual attention or arousal in the maternal odor context. Altogether, these experiments provide evidence for the tuning of face(like) categorization from multisensory inputs in the developing brain. They accord with the view that perceptual development integrates information across the senses for efficient category acquisition, with early-maturing systems, such as olfaction, providing assistance to later-developing systems, such as vision.

L’Homme est au cœur de mes questionnements ; toutefois la prise en compte de son environnement, qu’il soit physique ou encore émotionnel, est indispensable dans ma conception de son étude. Au cours de mon cursus scientifique dans le champ des STAPS, j’ai investi différentes problématiques chez l’Homme notamment celle de sa perception des espaces et celle de l’intime relation qu’il entretient avec son environnement. A partir d’une approche hypothético-déductive, mes analyses ciblent les contributions sensorielles (somesthésiques, proprioceptives, graviceptives…) dans ses élaborations cognitives (perceptions, attentions, représentations…) et leur conséquences motrices (posture, locomotion, mobilité…). Aujourd’hui, je défends l’idée selon laquelle l’action ne peut plus être considérée comme une simple sortie d’exécution.Tout au long de ce document, j’énonce différents projets expérimentaux, chez l’Homme en développement, sain ou encore pathologique, qui visent à démontrer que la cognition et le comportement moteur sont deux éléments indissociables d’une même entité, l’un impactant l’autre et réciproquement. Seule une approche contextualisée de l’Homme me semble pertinente pour mettre à jour les relations fonctionnelles entre ses activités cognitives et ses activités motrices.

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International audience; Communication réalisée dans le cadre de l'atelier de "Co-design e-santé & maladies rares" organisé par la Fondation Maladies rares. Cette communication présente l'intérêt qu'il y a à développer la co-conception participative et itérative de dispositifs innovants, sur la base du travail menée dans le cadre du projet Philomène (financé par la Fondation Maladies Rares).

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La pandemie liee au COVID-19 a conduit la France a imposer un confinement strict, affectant les habitudes des familles dans de nombreux domaines Cette etude visait a evaluer les changements possibles dans les comportements alimentaires des enfants, les pratiques educatives parentales en matiere d'alimentation et les motivations d'achat des aliments, pendant le confinement par rapport a la periode avant confinement Pendant le confinement, les parents de 498 enfants âges de 3 a 12 ans (238 garcons ;M = 7,32 ;ET = 2,27) ont repondu a une enquete nationale en ligne comprenant les items issus de questionnaires valides (ex CEDQ, CEBQ, HomeSTEAD) Ils ont decrit leur situation et celle de l'enfant pendant le confinement, et retrospectivement sur la periode le precedant (volet quantitatif) L'enquete comprenait aussi trois questions ouvertes (volet qualitatif) pour lesquelles les parents pouvaient partager leurs experiences positives et negatives concernant l'alimentation familiale durant cette periode, et ce qu'ils aimeraient maintenir au-dela Dans le volet quantitatif de l'etude, de nombreux parents ont signale des changements dans les comportements alimentaires des enfants (60 %), dans les pratiques educatives (65 %) et dans les motivations d'achat des aliments (85 %) Lorsque des changements etaient decrits, l'appetit de l'enfant, le plaisir a manger, la « reactivite aux aliments », le « manger emotionnel » et la frequence des collations augmentaient Aussi, 53 % des parents rapportaient une augmentation du niveau d'ennui de leur enfant L'ennui accru des enfants predisait de maniere significative une augmentation de la « reactivite aux aliments » et de la frequence des collations entre les repas Lorsque les parents ont change leurs pratiques, ils sont devenus plus permissifs : moins de regles, plus d'apaisement avec la nourriture (« soothing with food »), plus d'autonomie de l'enfant dans le choix des aliments a consommer, dans les quantites consommees, et du lieu de consommation Les parents achetaient plus frequemment des aliments « plaisir » et durables, preparaient plus de repas « faits maison » et cuisinaient davantage avec l'enfant Ces changements des pratiques et motivations des parents etaient expliques par le niveau d'etude, la situation professionnelle et financiere et l'augmentation du niveau de stress Les analyses du volet qualitatif revelent, sur le versant vecu positivement, une reappropriation de l'alimentation tant sur la qualite des aliments choisis (locaux, frais ) que sur les pratiques (importance du « fait-maison », de la transmission ), et un plaisir affirme de cuisiner ensemble et de partager les repas Sur le versant negatif, les parents soulignent la surcharge imposee par la frequence des repas a preparer, le stress et la surconsommation Le confinement a entraine des changements notables dans les habitudes alimentaires des familles : les comportements et pratiques sont devenus plus centres sur l'enfant, et plus axes sur les valeurs de plaisir, de commensalite et de durabilite [ABSTRACT FROM AUTHOR] Copyright of Nutrition Clinique et Metabolisme is the property of Elsevier B V and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Emotional feedback, such as faces showing emotions, can influence decision making. Decision making and emotional face processing, mainly mediated by the prefrontal and cingulate cortices, are impaired in suicide attempters. Here, we used functional MRI (fMRI) to study prefrontal activation in suicide attempters during a modified version of the Iowa Gambling Task (IGT) that included emotional face feedback. We randomly distributed the 116 euthymic women (n = 45 suicide attempters, n = 41 affective controls with history of depression without suicide attempt, and n = 30 healthy controls) included in the study in three emotional IGT groups: concordant (safe and risky choices followed by happy and angry faces, respectively), discordant (safe and risky choices followed by angry and happy faces, respectively), and neutral condition (safe and risky choices followed by neutral faces). Considering the two IGT phases (ambiguous and risky), we then analyzed five regions of interest during the risky vs. safe choices: orbitofrontal (OFC), anterior cingulate (ACC), ventrolateral (VLPFC), medial (MPFC) and dorsal prefrontal (DPFC) cortices. We found: (1) impaired decision making and increased DPFC and OFC activation in suicide attempters vs. controls in the discordant condition during the risky phase; (2) reduced VLPFC activation in suicide attempters in the concordant condition during the ambiguous phase; and (3) decreased OFC, ACC and DPFC activation in both control groups in the concordant condition during the ambiguous phase. Suicide attempters showed prefrontal alterations during reward-learning decision making with emotional feedback. Suicide attempters may guide their decisions to avoid social negative feedback despite the expected outcome.

BackgroundTo avoid a surge of demand on the healthcare system due to the COVID-19 pandemic, we must reduce transmission to individuals with chronic conditions who are at risk of severe illness with COVID-19. We aimed at understanding the perceptions, context and attitudes of individuals with chronic conditions during the COVID-19 pandemic to clarify their potential risk of infection.MethodsA cross-sectional survey was nested in ComPaRe, an e-cohort of adults with chronic conditions, in France. It assessed participants' perception of their risk of severe illness with COVID-19; their context (i.e., work, household, contacts with external people); and their attitudes in situations involving frequent or occasional contacts with symptomatic or asymptomatic people. Data were collected from March 23 to April 2, 2020, during the lockdown in France. Analyses were weighted to represent the demographic characteristics of French patients with chronic conditions. The subgroup of participants at high risk according to the recommendations of the French High Council for Public Health was examined.ResultsAmong the 7169 recruited participants, 63% patients felt at risk because of severe illness. About one quarter (23.7%) were at risk of infection because they worked outside home, had a household member working outside home or had regular visits from external contacts. Less than 20% participants refused contact with symptomatic people and ConclusionIndividuals with chronic conditions have distorted perceptions of their risk of severe illness with COVID-19. In addition, they are exposed to COVID-19 due to their context or attitudes.

Coordinated motion and collective decision-making in fish schools result from complex interactions by which individuals integrate information about the behavior of their neighbors. However, little is known about how individuals integrate this information to take decisions and control their motion. Here, we combine experiments with computational and robotic approaches to investigate the impact of different strategies for a fish to interact with its neighbors on collective swimming in groups of rummy-nose tetra (Hemigrammus rhodostomus). By means of a data-based agent model describing the interactions between pairs of H. rhodostomus (Calovi et al., 2018), we show that the simple addition of the pairwise interactions with two neighbors quantitatively reproduces the collective behavior observed in groups of five fish. Increasing the number of interacting neighbors does not significantly improve the simulation results. Remarkably, and even without confinement, we find that groups remain cohesive and polarized when each agent interacts with only one of its neighbors: the one that has the strongest contribution to the heading variation of the focal agent, dubbed as the “most influential neighbor”. However, group cohesion is lost when each agent only interacts with its nearest neighbor. We then investigate by means of a robotic platform the collective motion in groups of five robots. Our platform combines the implementation of the fish behavioral model and a control system to deal with real-world physical constraints. A better agreement with experimental results for fish is obtained for groups of robots only interacting with their most influential neighbor, than for robots interacting with one or even two nearest neighbors. Finally, we discuss the biological and cognitive relevance of the notion of “most influential neighbors”. Overall, our results suggest that fish have to acquire only a minimal amount of information about their environment to coordinate their movements when swimming in groups., Author summary How do fish integrate and combine information from multiple neighbors when swimming in a school? What is the minimum amount of information about their environment needed to coordinate their motion? To answer these questions, we combine experiments with computational and robotic modeling to test several hypotheses about how individual fish could integrate and combine the information on the behavior of their neighbors when swimming in groups. Our research shows that, for both simulated agents and robots, using the information of two neighbors is sufficient to qualitatively reproduce the collective motion patterns observed in groups of fish. Remarkably, our results also show that it is possible to obtain group cohesion and coherent collective motion over long periods of time even when individuals only interact with their most influential neighbor, that is, the one that exerts the most important effect on their heading variation.

Machine learning approaches have seen considerable applications in human movement modeling, but remain limited for motor learning. Motor learning requires accounting for motor variability, and poses new challenges as the algorithms need to be able to differentiate between new movements and variation of known ones. In this short review, we outline existing machine learning models for motor learning and their adaptation capabilities. We identify and describe three types of adaptation: Parameter adaptation in probabilistic models, Transfer and meta-learning in deep neural networks, and Planning adaptation by reinforcement learning. To conclude, we discuss challenges for applying these models in the domain of motor learning support systems., Comment: Mini Review, Frontiers Comput. Sci. - Human-Media Interaction

International audience; Nowadays, there are very few connections between physics and cognitive psychology. But in this paper, we assume that recent models inspired by concepts issued from physics and problem-solving cognitive processes like the Model Human Processor with Real Time Constraints (MHP/RT) model (Kitajima and Toyota, 2012) [1] allow to better describe and predict human behaviors especially in complex and dynamical environments where interactions between several bands and space-time constraints exist. After presenting the importance of the concept of resonance in physics and in cognitive psychology, the deterministic chaos in human action and behavior will be described, by focusing on an innovative model directly inspired by models issued from physics and problem-solving cognitive processes, Model Human Processor With Real Time Constraints (MHP/RT). If nowadays, the distance between physics and psychology is very prominent, the main goal of this paper is to defend the necessity to (re-)create strong relationships between physics and psychology to better understand and predict human behaviors because these situations are the majority of situations where an individual takes actions (such as walks, reads, stops, watching the other pedestrians' behavior in complex buildings or in street, etc.).

International audience; Les neurosciences de la relation à l’autre. Le principal enjeu scientifique des neurosciences des interactions sociales est de créer et/ou consolider les interfaces des sciences biologiques avec les sciences humaines et sociales. Ces interfaces sont essentielles pour progresser dans l’étude du comportement, de sa genèse, de son évolution tout au long de la vie, et de ses altérations. Pour bien en comprendre les enjeux, il faut rappeler l’interaction entre le stress, quelles qu’en soient les causes [...]

Author-generated preprint; International audience; The nests of termites are amongst the most diverse and complex structures among the great diversity of those built by animals. Their intricate architectures and the manner in which termites make use of them have fascinated mankind for centuries, whether it is part of local agricultural practice, as a simple landscape feature, as an inspiration for societal collective building or as a scientific study object on its own. However, their nests remain relatively little understood compared to those of many ants, social wasps and social bees, especially honey bees and stingless bees since termites that actually build mounds or other conspicuous structures are of minor economic importance. The few termites that serve as structural pests-and so attract the most study-mostly live inside their food supply without constructing a distinctive nest. My purpose here is to build on the few earlier reviews with an emphasis on mound nests. Many recent advances have been possible thanks to new imaging technics such as Computer Tomography, photogrammetry or automatic tracking and behavior classification. Modelling and simulation techniques further help to link individual construction behavior to emerging architectures.

International audience; BACKGROUND:While patient-centered care is recommended as a key dimension for quality improvement, in case of serious illness, patients may have different expectations regarding information and participation in medical decision-making. In oncology, anticipation of disease worsening remains difficult, especially when patient's preferences towards prognosis medical information are unclear. Valid tools to explore patients' preferences could help targeting end-of-life discussions, which have been shown to decrease aggressiveness of end-of-life care. Our aim was to establish the validity and reliability of the French version of the Autonomy Preference Index (API) among patients with incurable cancer and in primary care setting. Three supplementary items were specifically developed to evaluate preparedness to anticipate disease deterioration among patients with incurable cancer.METHODS:The psychometric properties of the API translated into French were assessed among patients consecutively recruited from January to March 2017 in the waiting rooms of 19 general practitioners (N = 391) and in an oncology (N = 187) clinic in Paris. Relationships between the newly-developed items and the API subscale scores were studied.RESULTS:A three correlated factors confirmatory model (two factors related to decision-making and a factor related to information-seeking preferences) showed an acceptable fit on the whole sample and no measurement invariance issue was found across settings, age, sex and educational level. Internal consistency and test-retest reliability were acceptable for the information-seeking and decision-making subscales. One of the newly-developed items on patients' ability to anticipate a decision on the use of artificial respiration if a sudden deterioration of their illness occurred was not related to the API subscale scores.CONCLUSION:The French version of the API was found valid and reliable for use in general practice and oncology settings. The additional items on patient preparedness to anticipate disease deterioration can be of interest to ensure that patient values guide all end-of-life clinical decisions.

Current computational and neuroscientific models of decision-making posit a discrete, serial processing distinction between upstream decisional stages and downstream processes of motor-response implementation. We investigated this framework in the context of two-alternative forced-choice tasks on linguistic stimuli, words and pseudowords. In two experiments, we assessed the impact of lexical frequency and action semantics on two effector-selective EEG indexes of motor-response activation: the lateralized readiness potential and the lateralization of beta-frequency power. This allowed us to track potentially continuous streams of processing progressively mapping the evaluation of linguistic stimuli onto corresponding response channels. Whereas action semantics showed no influence on EEG indexes of motor-response activation, lexical frequency affected the lateralization of response-locked beta-frequency power. We argue that these observations point toward a continuity between linguistic processing of word input stimuli and implementation of corresponding choice in terms of motor behavior. This interpretation challenges the commonly held assumption of a discrete processing distinction between decisional and motor-response processes in the context of decisions based on symbolic stimuli.

Every day we make decisions about the actions we want to perform. These decisions are based on a trade-off between the benefits we hope to obtain from performing these actions, and the costs, in terms of effort, associated with those actions. This thesis examines the neural correlates of the cost/benefit trade-off through three studies conducted in healthy participants using functional magnetic resonance imaging. In the first study, we were able to dissociate the neural correlates of the computation of the cost/benefit trade-off from the neural correlates of the variables regulating this computation. Indeed, in this study, the computation of the cost/benefit trade-off was associated with the ventromedial prefrontal cortex, whereas confidence in the decision and the time spent in deliberating were associated with more dorsal parts of the medial prefrontal cortex. With our second study, we observed that, in two tasks, involving a mental or a physical effort, the performance was better explained by a Pavlovian bias than by loss aversion. In other words, as opposed to what has been shown mainly in choice tasks, individuals tended to give more weight to gains than to losses. The third study allowed us to show that, even in a simple reinforcement learning task, the brain areas linked to the exertion of a mental effort were recruited while the cost/benefit trade-off was being computed, suggesting that this task was not carried out purely automatically. All these results allow us to better characterize the brain areas involved in the cost/benefit trade-off and the conditions in which these areas are active., Tous les jours, nous prenons des décisions sur les actions que nous souhaitons entreprendre. Ces décisions se fondent sur un compromis entre les bénéfices que nous espérons obtenir après avoir effectué ces actions, et les coûts, en termes d’effort, associés à ces actions. Cette thèse s’intéresse aux bases cérébrales du compromis coûts/bénéfices au travers de trois études menées chez des participants sains à l’aide de l’imagerie par résonance magnétique fonctionnelle. Dans la première étude, nous avons pu dissocier les bases cérébrales du calcul du compromis coûts/bénéfices des bases cérébrales des variables régulant ce calcul. En effet, dans cette étude, le calcul du compromis coûts/bénéfices était associé au cortex préfrontal ventromédian alors que la confiance dans la décision et le temps passé à délibérer étaient associés à des parties plus dorsales du cortex préfrontal médian. La seconde étude a permis de montrer que, dans deux tâches, impliquant un effort mental ou physique, la performance s’expliquait mieux par un biais pavlovien, donnant plus de poids aux gains qu’aux pertes, que par une aversion à la perte, telle qu’elle a été caractérisée principalement dans des tâches de choix. La troisième étude nous a permis de montrer que, même dans une tâche simple d’apprentissage par renforcement, les aires cérébrales liées à l’exécution d’un effort mental étaient recrutées au moment du calcul du compromis coûts/bénéfices, suggérant que cette tâche n’était pas effectuée de manière purement automatique. L’ensemble de nos résultats permet de mieux caractériser les aires cérébrales impliquées dans le compromis coûts/bénéfices et les conditions dans lesquelles ces aires sont actives.

International audience; Rationale Behavioral disturbances (BD) are prevalent in patients with substance use disorders (SUD). Objectives To test the hypothesis that chronic exposure to cocaine could favor the acquisition of BD that were not present in childhood. Methods We used child and adult ADHD self-report screening scales (WURS-25 and ASRS-6, respectively, with their usual threshold) as assessment tools for significant BD. In a cross-sectional assessment of 382 patients with multiple SUD, we investigated BD and then "de novo" BD (i.e., by restricting the sample to patients below the threshold for childhood BD) (N = 214). We also tested for a gradient effect between patients' lifetime DSM IV cocaine and opioid dependence status and the prevalence of BD. Results BD were found in 188/382 (42.9%) subjects and in 74/214 (34.6%) subjects. Three clinical factors were associated with BD in the whole sample: the number of cocaine dependence criteria (OR = 1.36 [1.14-1.64], p = 0.001), the number of opioid dependence criteria (OR = 0.69 [0.52-0.91], p = 0.010), and a personal history of using cocaine through rapid routes of administration (OR = 0.41 [0.19-0.88], p = 0.022). The same three factors were associated with "de novo" BD in the restricted sample: OR = 1.35 ([1.11-1.63], p = 0.002), OR = 0.83 ([0.70-0.99], p = 0.046), and OR 0.37 ([0.16-0.86], p = 0.022), respectively. There were significant gradients for BD according to the cocaine exposure categories in the whole (Mantel-Haenszel, p < 0.001) and in the restricted sample (Mantel-Haenszel, p = 0.002). Conclusions Cocaine exposure was positively associated with behavioral disturbances in a dose-dependent manner in this clinical sample, whilst opioid exposure showed a negative association.

Hydroxychloroquine, an essential treatment for many patients with rheumatologic conditions, has garnered widespread attention as a potential treatment for COVID-19 infection. The authors appraise t...

Introduction: This thesis comprises four separate studies that assessed the psychological status of patients who underwent traumatic amputations of the upper limb due to a lack of surgical options that could have prevented part of the limb from being amputated. The main objectives of these four studies were to: Firt study, identify the cases that involved traumatic amputation of the upper limb. Second study, determine the occurrence of pathological traumatic grief following upper limb traumatic amputation. Third study, assess the proportion of patients who had undergone an upper limb traumatic amputation who claimed to have overcome the direct functional consequences of the accident and who did not exhibit signs of pathological grief. Fourth study, assess whether patients more often seek a secondary amputation of a long finger injured in a work accident compared to other types of accidents.Materials & Methods: This thesis was carried out over the course of 11 years at an ‘SOS Mains Adulte’ unit. It involved collection of the medical records of patients treated for a traumatic amputation, using the CCAM (the French Common Classification of Medical Procedures) codes for upper limb rectifications and transplants. Only information regarding full and supported traumatic amputations of the upper limb was compiled. All anatomical levels were considered. Non-traumatic and/or incomplete amputations were excluded, as was the pediatric population (patients under 16 years of age). In the first study, we determined the incidence of traumatic amputations, as well as the proportion of transplant attempts and the failure rate. The epidemiological profiles of the patients were also studied. In the second study, we established the proportion of pathological traumatic mourning in the population of amputated upper limb patients for whom there was not a surgical solution or who could not be successfully transplanted. The risk factors for pathological mourning were also studied. In the third study, we assessed whether there was a correlation between the absence of traumatic pathological mourning and the personal feeling of having returned to the original state in patients who had undergone traumatic upper limb amputations. In the fourth study, we assessed whether patients were more likely to seek a secondary metacarpal base amputation based on whether the accident had taken place in the workplace.Results: The first study: Over the period in question, we identified 1,715 traumatic amputations and an annual incidence of 3% in the population admitted to the emergency department. A transplant was involved in 1%, with 583 identified cases. The second study: A state of traumatic pathological mourning was identified in 39% of the 524 included patients. Both thumb amputation and transplant failure were risk factors for pathological mourning. The third study: None of the patients who claimed to have overcome the direct functional consequences of the accident also suffered from traumatic pathological mourning. Conversely, all of the patients with pathological mourning syndrome stated that they had not been able to overcome the direct functional consequences of the accident. The fourth study: The patients were more likely to seek a secondary amputation when the accident had taken place in the workplace Discussion: Although the incidence of traumatic amputations in the population of ‘SOS Mains’ patients is low, the extent of the functional, psychological, and social repercussions should not be trivialized. Indeed, this type of trauma leads to pathological traumatic mourning in more than a third of cases. This complication following amputation needs to be detected in a systematic and timely manner in order to reduce the impact of traumatic amputation of the upper limb on the lives of victims. However, the absence of traumatic pathological mourning is not synonymous with recovery after the occurrence of an amputation. It is important to assess the return to the original state, which appears to largely depend on the patient's acceptance of the new situation. Before undertaking a secondary metacarpal base amputation following a workplace accident, the surgeon needs to assess the patient’s reasons for seeking further surgery. It is possible that their intention is to use this surgery to obtain secondary material benefits. The patient's psychological distress also needs to be assessed., Introduction : Nous proposons dans ce travail, un regroupement de 4 études permettant d’évaluer le devenir psychologique des patients victimes d’une amputation traumatique au membre supérieur, où les solutions chirurgicales n’ont pu permettre la conservation du fragment amputé. Ces 4 études ont pour objectifs principaux, savoir : La première, de préciser l’incidence des amputations traumatiques au membre supérieur. La deuxième, de déterminer l’existence d’un deuil pathologique traumatique après la survenue d’une amputation traumatique au membre supérieur. La troisième, d’évaluer la proportion de patients victimes d’une amputation traumatique du membre supérieur affirmant avoir surmonté les conséquences de l’accident et ne présentant pas de deuil pathologique. La quatrième, d’apprécier les motivations des patients demandeurs d’une amputation secondaire d’un doigt long après un accident de travail comparativement aux patients blessés hors accidents de travail.Matériel & Méthodes : Il s’agit d’un travail rétrospectif mené sur une période de 11 ans, au sein d’un SOS Mains adulte. Les dossiers des patients pris en charge pour une amputation traumatique ont été recherchés. Cette sélection a été réalisée à l’aide des codes CCAM des actes de régularisations et de replantations au membre supérieur. Seules les amputations traumatiques complètes du membre supérieur et pris en charge ont été recensées. L’ensemble des niveaux anatomiques a été considéré. Les amputations non traumatiques et/ou incomplètes ont été exclues de même que la population pédiatrique (âge inférieur à 16 ans). Pour la première étude, nous avons déterminé l’incidence des amputations traumatiques ainsi que la proportion de tentatives de replantations, et ses échecs. Le profil épidémiologique des patients a également été étudié. Pour la deuxième étude, nous avons établi la proportion de deuil pathologique traumatique dans la population des patients amputés au membre supérieur sans solutions chirurgicales ou après échec d’une replantation. Les facteurs de risque de deuil pathologique ont été étudiés. Pour la troisième étude, nous avons tenté de déterminer chez les patients victimes d’une amputation traumatique du membre supérieur, l’existence d’une corrélation entre l’absence de deuil pathologique traumatique et le sentiment personnel d’être revenu à l’état antérieur. Pour la quatrième étude, nous avons apprécié les motivations des patients demandeurs d’une amputation secondaire basimétacarpienne en fonction de la survenue de cet accident dans le contexte professionnel ou non.Résultats : Première étude : Sur la période donnée, nous avons identifié 1715 amputations traumatiques, et identifié une incidence annuelle à hauteur de 3% dans la population admise aux urgences mains. L’incidence des replantations était de 1%, avec 583 cas identifiés. Deuxième étude : Sur les 524 patients inclus, un état de deuil pathologique traumatique était identifié dans 39% des cas. L’amputation du pouce était un facteur de risque de deuil pathologique de même que l’absence de tentative de replantation. Troisième étude : Les patients affirmant avoir surmonté les causes de l’accident ne présentaient jamais d’arguments pour un deuil pathologique traumatique. À l’inverse, la totalité des patients présentant un syndrome de deuil pathologique confirmait ne pas avoir réussi à surmonter les conséquences de l’accident. Quatrième étude : La survenue de cet accident sur le lieu de travail influençait les motivations des patients demandeurs d’une amputation secondaire.Discussion : L’incidence des amputations traumatiques dans la population des patients d’un SOS Mains reste faible, mais l’importance du retentissement fonctionnel, psychologique, et social ne doit pour autant être négligée. Ce traumatisme est à l’origine d’un deuil pathologique traumatique dans plus d’un tiers des cas. Cette complication doit être dépistée systématiquement et précocement afin d’en réduire l’impact dans la vie des victimes d’une amputation traumatique au membre supérieur. Pour autant, l’absence de deuil pathologique traumatique n’est pas synonyme de guérison après la survenue d’une amputation. Il est important d’évaluer le retour à l’état antérieur qui semble signer l’acceptation de la nouvelle situation par le patient. La réalisation d’une amputation basimétacarpienne secondaire dans les suites d’un accident de travail doit amener le chirurgien à s’interroger sur les motivations précises du patient. Hormis, la volonté d’instrumentaliser cette chirurgie afin d’obtenir des bénéfices secondaires matériels. La détresse psychologique du patient doit-être évaluée.

Human emotions guide verbal and non-verbal behaviour during social encounters. During public performances, performers’ emotions can be affected directly by an audience’s attitude. The valence of the emotional state (positive or negative) of a broad range of animal species is known to be associated with a body and visual orientation laterality bias. Here, we evaluated the influence of an audience’s attitude on professional actors’ head orientation and gaze direction during two theatrical performances with controlled observers’ reactions (Hostile vs Friendly audience). First, our speech fluency analysis confirmed that an audience’s attitude influenced actors’ emotions. Second, we found that, whereas actors oriented more their head to the left (i.e. Right Hemisphere Bias) when the audience was hostile, they gazed more straight ahead at Friendly spectators. These results are in accordance with the Valence-Specific Hypothesis that proposes that processing stimuli with negative valences involves the right hemisphere (i.e. left eye) more than the left hemisphere.

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International audience; Emotions play a key role in our daily life through their control over our thoughts and behaviors. While it is commonly accepted that depressive patients have emotional perception disorders, it is important to know how these disorders affect patients’ sensory perception to develop products to provide them with better support.In this study, we first examined the existence of modifications in the emotional perception of subjects with minor depressive symptoms (MDS, n=80) compared with healthy controls (HC, n=80) using a nonverbal method based on pictures to measure projected emotions and personality traits: the Sense’n Feel™ method. The investigated stimuli were two unpleasant and two pleasant odors and one pleasant food product: a madeleine. Second, we investigated the hedonic, familiarity and intensity olfactory perceptions of the subjects using the same stimuli.No significant difference was found in any olfactory qualities between the two groups. Concerning the pleasant olfactory stimuli, however, we did note that the MDS subjects had a significantly lower score for the positive emotion of joy/happiness than the controls. Additionally, the MDS group’s attribution of some positive personality traits for the three pleasant stimuli was significantly weaker than that in the HC group.These results could be explained by the affective state of the MDS subjects; they were more anxious and more alexithymic compared with the controls. Further research is needed to validate our study in clinically depressed individuals and to determine whether the modifications of the emotional olfactory perception are due to the disease and/or to neuropsychological alterations.

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Humans considerably vary in the degree to which they rely on their peers to make decisions. Why? Theoretical models predict that environmental risks shift the cost-benefit trade-off associated with the exploitation of others’ behaviours (public information), yet this idea has received little empirical support. Using computational analyses of behaviour and multivariate decoding of electroencephalographic activity, we test the hypothesis that perceived vulnerability to extrinsic morbidity risks impacts susceptibility to social influence, and investigate whether and how this covariation is reflected in the brain. Data collected from 261 participants tested online revealed that perceived vulnerability to extrinsic morbidity risks is positively associated with susceptibility to follow peers’ opinion in the context of a standard face evaluation task. We found similar results on 17 participants tested in the laboratory, and showed that the sensitivity of EEG signals to public information correlates with the participants’ degree of vulnerability. We further demonstrated that the combination of perceived vulnerability to extrinsic morbidity with decoding sensitivities better predicted social influence scores than each variable taken in isolation. These findings suggest that susceptibility to social influence is partly calibrated by perceived environmental risks, possibly via a tuning of neural mechanisms involved in the processing of public information.

International audience; BACKGROUND: Findings from efficacy trials of group psychoeducation (PE) for bipolar disorders (BD) led to its inclusion in evidence-based guidelines as a first-line mandatory treatment. However, pragmatic trials and observational studies are needed to determine its real-world effectiveness, impact on outcomes deemed important to patients and to clarify potential mediators of any benefits. METHODS: Individuals with BD were offered the opportunity to participate in 20h of PE and asked to complete pre- and post-intervention ratings of symptoms, knowledge about BD, medication adherence, and illness perception. A priori, two key patient outcomes were identified (social functioning and self-esteem); sample attrition due to dropout or relapse was recorded. RESULTS: Of 156 individuals who completed the pre-PE assessments, 103 completed the program and post-PE assessments. Only 4 of 53 dropouts were associated with BD relapse. Post-intervention, the PE completers demonstrated a statistically significant improvement in social functioning (p = 0.003, Effect Size (ES) = 0.26) and a trend towards improved self-esteem (ES = 0.14). Whilst there were significant changes in medication adherence (p = 0.002, ES = 0.28), knowledge of BD (p < 0.001, ES = 1.20), and illness perception (p < 0.001, ES = -0.37), mediational analysis demonstrated that only change in illness perception was associated to change in functioning (p=0.03) with no contribution from changes in knowledge of BD or medication adherence. CONCLUSIONS: In real-world settings, over 60% individuals completed 10-session course of PE. After controlling for demography and baseline clinical state, change in illness perception, rather than change in knowledge or medication adherence, emerged as a potential mediator of some benefits of PE.

The synaptosomal-associated protein SNAP25 is a key player in synaptic vesicle docking and fusion and has been associated with multiple psychiatric conditions, including schizophrenia, bipolar disorder, and attention-deficit/hyperactivity disorder. We recently identified a promoter variant inSNAP25,rs6039769, that is associated with early-onset bipolar disorder and a higher gene expression level in human prefrontal cortex. In the current study, we showed that this variant was associated both in males and females with schizophrenia in two independent cohorts. We then combinedin vitroandin vivoapproaches in humans to understand the functional impact of the at-risk allele. Thus, we showedin vitrothat thers6039769C allele was sufficient to increase theSNAP25transcription level. In a postmortem expression analysis of 33 individuals affected with schizophrenia and 30 unaffected control subjects, we showed that theSNAP25b/SNAP25aratio was increased in schizophrenic patients carrying thers6039769at-risk allele. Last, using genetics imaging in a cohort of 71 subjects, we showed that male risk carriers had an increased amygdala–ventromedial prefrontal cortex functional connectivity and a larger amygdala than non-risk carriers. The latter association has been replicated in an independent cohort of 121 independent subjects. Altogether, results from these multilevel functional studies are bringing strong evidence for the functional consequences of this allelic variation ofSNAP25on modulating the development and plasticity of the prefrontal–limbic network, which therefore may increase the vulnerability to both early-onset bipolar disorder and schizophrenia.SIGNIFICANCE STATEMENTFunctional characterization of disease-associated variants is a key challenge in understanding neuropsychiatric disorders and will open an avenue in the development of personalized treatments. Recent studies have accumulated evidence that the SNARE complex, and more specifically the SNAP25 protein, may be involved in psychiatric disorders. Here, our multilevel functional studies are bringing strong evidence for the functional consequences of an allelic variation ofSNAP25on modulating the development and plasticity of the prefrontal–limbic network. These results demonstrate a common genetically driven functional alteration of a synaptic mechanism both in schizophrenia and early-onset bipolar disorder and confirm the shared genetic vulnerability between these two disorders.

International audience; Background and aims Gambling disorder-related illegal acts (GDRIA) are often crucial events for gamblers and/or their entourage. This study was designed to determine the predictive factors of GDRIA. Methods Participants were 372 gamblers reporting at least three DSM-IV-TR (American Psychiatric Association, 2000) criteria. They were assessed on the basis of sociodemographic characteristics, gambling-related characteristics, their personality profile, and psychiatric comorbidities. A multiple logistic regression was performed to identify the relevant predictors of GDRIA and their relative contribution to the prediction of the presence of GDRIA. Results Multivariate analysis revealed a higher South Oaks Gambling Scale score, comorbid addictive disorders, and a lower level of income as GDRIA predictors. Discussion and conclusion An original finding of this study was that the comorbid addictive disorder effect might be mediated by a disinhibiting effect of stimulant substances on GDRIA. Further studies are necessary to replicate these results, especially in a longitudinal design, and to explore specific therapeutic interventions.

Live organisms are not isolated in their environments. They are in contact with siblings, partners, predators and competitors in a shared environment where, to survive, they must be able to orient themselves but also organize and feed themselves. Thus, they must interact with each other and from these complex interactions emerge an evolutionary force. Understanding these interactions, which are at the heart of species adaptation, is a key question in evolutionary biology. This adaptation is a driving force of species evolution, depending on a communication system which allows individuals to obtain information about their surrounding environments. Back-and-forth message sharing represents the main component of the communication between a transmitter and a receiver, between a source and a receptor. Based on information from biotic and abiotic sources, individuals modify their behaviors. Therefore, a behavioral polymorphism emerges, which involves modifications of other organisms and of the surrounding abiotic factors as well. The individual emitting this behavior, will modify its physiology, its gene expression and sometimes its morphology. The double modification of the individual's internal and external factors defines the dynamic "environment - gene - behavior". Communication systems thus play a central role in ecological interactions (individual-environment interactions). Based on communication signals emitted in the environment, they act on gene expression and modify the behavioral responses of individuals.In the following discussion, I summarize my work on communication in insects through the study of communication signals, the formation of these signals, the adaptation of species to their environment using different perceived signals and the mechanisms of the behavioral polymorphism through specialized communication channels. The direct observable results from communication systems is behavior, therefore it represents the main focus of my studies. Through the prism of my own work, we will discover how a communication signal is produced, centralized and then how it circulates between individuals to eventually change their behaviors, their ability to adapt to environmental constraints and to finally end up changing their own future through the modification of their gene expression and their phenotype., Les organismes vivants ne sont pas isolés dans leurs environnements. Ils côtoient des semblables, des partenaires, des prédateurs et des compétiteurs dans un milieu où ils doivent s'orienter, s'organiser, se substanter pour survivre. Ainsi les êtres vivants interagissent tous les uns avec les autres et de ces interactions complexes émergent une force évolutive. Comprendre ces relations qui sont au centre de l'adaptation des espèces à leur environnement est une question centrale en biologie évolutive. Force majeure de l'évolution, cette adaptation dépend d'un système de communication qui permet aux individus d'obtenir des informations sur ce qui les entourent. Une relation dynamique d'échange de messages forme la nature même de la nécessité de communication, entre un émetteur et un receveur, entre une source et un récepteur. C'est sur cette base d'informations provenant de sources biotiques et abiotiques, que les individus modifient leurs comportements. Ainsi, un polymorphisme comportemental émerge, influençant par la même les autres organismes et les autres facteurs abiotiques avoisinants. L'individu lui-même émetteur de ce comportement va modifier sa physiologie, l'expression de ses gènes, voire sa morphologie. La double modification des facteurs externes et internes de l'individu définit la dynamique "environnement – gène – comportement". Les systèmes de communication ont donc un rôle central dans les interactions écologiques (interactions individu–environnement), s'appuyant sur des signaux de communication émis dans l'environnement, ils agissent sur l'expression génique des individus et modifient leurs réponses comportementales.Dans l'exposé qui suit, je résume mes travaux sur la communication chez les insectes à travers l'étude des signaux de communication, la formation de ces signaux, l'adaptation des espèces à leurs environnements en utilisant les différents signaux perçus et le fonctionnement du polymorphisme comportemental via des canaux de communication spécialisés. Le comportement est la résultante observable des systèmes de communication, il représente donc l'objet principal quantifiable de mes travaux, tout en y étant intimement lié. Ainsi à travers le prisme de mes travaux, nous allons découvrir comment un signal de communication est produit, centralisé puis circule entre les individus pour finir par modifier leurs comportements, leurs capacités d’adaptation face aux contraintes environnementales jusqu’à changer leurs propres devenir en modifiant l’expression de leurs gènes et leurs phénotypes.

BACKGROUND: Hypertension is the most common chronic disease worldwide and a significant risk factor for cardiovascular diseases. Modifiable risk factors contribute partially to an increasing prevalence and inadequate blood pressure control. On this basis, non-pharmacological recommendations are available in worldwide guidelines for the prevention and management of hypertension. These measures include: maintain a normal body weight, engage in regular physical activity, limit alcohol consumption, reduce dietary salt intake and adhere to a healthy diet. OBJECTIVES: The objective of this thesis is to study the determinants of high blood pressure and to evaluate the relationship between lifestyle behavior and hypertension. In particular, the aim is to investigate the influence of an unhealthy behavior on blood pressure and the magnitude of the individual and combined effect of lifestyle factors on hypertension and blood pressure control. METHODS: Cross-sectional analyses were conducted using data from a representative sample of the adult Lebanese population and the French CONSTANCES cohort study. The Lebanese sample consisted of 2088 adults aged 20 years and above randomly selected following a sampling scheme across Lebanon. While CONSTANCES is an ongoing prospective cohort that included between February 2012 and January 2018 a total of 87,808 volunteer participants aged 18–69 randomly selected from the National Health Insurance Fund. In both studies, blood pressure measurements were done following standard operational procedures and lifestyle behaviors were assessed using self-reported validated questionnaires. Mostly, logistic regression models and general linear models were used to estimate the magnitude of the associations and to study adjusted mean blood pressure parameters, respectively. Adjusted odds ratios were presented along with 95% confidence interval. Statistical analyses were conducted using different statistical analysis software. RESULTS: Results of this thesis describe a high prevalence of hypertension and poor blood pressure control among treated individuals in the Lebanese population. While in France, epidemiologic data are in accordance with results of recent studies. From the conducted 3 analyses, increased body mass index (obesity and overweight), heavy alcohol consumption and non-adherence to dietary recommendations were seen to be independently associated with hypertension and poor blood pressure control, and they influenced systolic blood pressure levels. Controversial results were seen with physical activity in both studies and across different study populations. In terms of the magnitude of the association, body mass index and adherence to dietary approaches to stop hypertension (DASH) diet seem to have the biggest impact on increasing the odds of hypertension and uncontrolled blood pressure. Moreover, a combination of unhealthy behavior increased the odds of hypertension by more than 1.5 times, which highlighted the detrimental effect of an overall poor lifestyle on the risk of hypertension. Furthermore our findings suggest that the extent to which these factors are associated with hypertension is different by gender. CONCLUSION: Findings of this thesis provided needed epidemiologic data on hypertension in Lebanon and France. They emphasize that non-adherence to widely recommended lifestyle modifications has important impact on the risk of hypertension and influences BP control. From a population-based perspective, these findings promote that a global healthy lifestyle through improvement of modifiable behaviors could have major benefits in the prevention of hypertension., CONTEXTE: L'hypertension est la maladie chronique la plus fréquente dans le monde et un facteur de risque majeur des maladies cardiovasculaires. Les facteurs de risque modifiables contribuent en partie à l'augmentation de la prévalence et au mauvais contrôle tensionnel. Dans ce contexte, des mesures non médicamenteuses sont largement recommandées dans les textes de recommandations des sociétés savantes afin de prévenir l’hypertension et/ou d’améliorer le contrôle tensionnel des individus hypertendus. Ces mesures comprennent : le maintien d’un poids normal, la pratique d’une activité physique régulière, une consommation d’alcool limitée, la réduction de la consommation de sel et l’adhérence à une alimentation équilibrée OBJECTIFS: L'objectif de cette thèse est d'étudier les déterminants comportementaux de l'hypertension artérielle. En particulier, l’objectif est d’étudier l’influence d’un mode de vie malsain sur la pression artérielle ainsi que l’ampleur de l’effet individuel et de l’effet combiné des facteurs comportementaux sur l’hypertension et le contrôle tensionnel. MÉTHODES: Des analyses transversales ont été menées d’une part sur un échantillon de 2088 adultes âgés de 20 ans représentatif de la population Libanaise et d’une autre part sur une cohorte d’adultes Français participants à l’étude prospective CONSTANCES. Entre Février 2012 et Janvier 2018, CONSTANCES est constituée d’un échantillon de 87 808 participants volontaires âgés de 18 à 69 ans représentatif de la caisse nationale d’assurance maladie. Les mesures de la pression artérielle ont été effectuées selon des protocoles opératoires standardisés et les données des comportements liés au mode de vie ont été recueillies à l'aide d’auto-questionnaires. Des modèles de régression logistique et des modèles linéaires généraux ont été utilisés pour estimer l'ampleur des associations et pour étudier les moyennes des paramètres de pression artérielle, respectivement. Les odds ratio ajustés ont été présentés avec un intervalle de confiance de 95%. Les données ont été analysées à l'aide de différents logiciels (SPPS and SAS). RESULTATS: Les résultats de cette thèse décrivent une prévalence élevée d'hypertension et du mauvais contrôle chez les hypertendus traités dans la population Libanaise. Les données épidémiologiques issues de CONSTANCES semblent similaires à celles d’autres études 5 Françaises récentes. D'après les analyses effectuées, un indice de masse corporelle élevé (obésité et surcharge pondérale), une forte consommation d'alcool et la non adhérence aux recommandations nutritionnelles ont été significativement associés à l'hypertension et au mauvais contrôle tensionnel. De plus, ces facteurs sont associés à une augmentation du niveau de la pression artérielle systolique. Des résultats divergents ont été observés concernant l'activité physique et ceci dans les deux études et parmi les différentes populations étudiées. En termes d’ampleur de l’association, l’indice de masse corporelle et l’adhésion au régime DASH semblent avoir l’impact le plus important sur l’augmentation du risque d’hypertension et du contrôle tensionnel. De plus, une combinaison de comportements malsains multiplie par plus de 1,5 le risque d'hypertension, ce qui met en évidence les effets néfastes d'un mode de vie généralement malsain sur le risque d'hypertension. De plus, nos résultats suggèrent que l’ampleur de l’association de ces facteurs à l'hypertension diffère selon le sexe. CONCLUSION: Les résultats de cette thèse rapportent des données épidémiologiques nécessaires sur l'hypertension au Liban et en France. Egalement, ces résultats suggèrent que la non-adhérence à l’ensemble des mesures non-médicamenteuses recommandées a un impact important sur le risque d'hypertension et influence le contrôle tensionnel.

Background The border area between French Guiana and Brazil is an active HIV-transmission zone. The aim of the present study was to describe HIV knowledge, risk and the level of stigma among inhabitants of this border area. Methods A cross-sectional study was conducted among 621 inhabitants over 18 years of age in the border cities of Saint-Georges-de-l’Oyapock in French Guiana and Oiapoque in Brazil. It was conducted between October 2017 and February 2018. An anonymous standardized questionnaire was filled out by culturally-trained mediators, then analyzed using STATA 12. Results Almost half (45.9%) of the individuals had a low education level. Participants whose native language was Portuguese or French demonstrated better HIV knowledge than other populations, notably native Amerindian and creole-speaking people. HIV risk behavior was more frequent in men and in younger age groups. People with good HIV knowledge reported having performed more HIV tests in the last year than participants with poor knowledge. The stigma level was high and reported in 74.8% of respondents. Conclusions These results illustrate the need for initiatives to improve HIV prevention among autochthonous populations on both sides of this border area. Cross-border collaboration on health policies could produce common key messages adapted to the education level and multi-linguistic populations who live in this area.

National audience

International audience; Depuis plusieurs années, divers programmes ont été mis en place pour impulser une dynamique numérique au sein des établissements scolaires. La Région Grand Est ne fait pas exception, avec notamment le “Lycée 4.0”. Ce dispositif, qui opte pour le remplacement des livres scolaires par des manuels numériques, implique l’intégration massive de matériels et de ressources numériques dans les lycées. Les élèves et les enseignants bénéficient alors d’un ensemble d’outils numériques utilisables à la fois dans l’établissement scolaire et à domicile. Le travail de recherche répond à une demande du terrain et vise l’analyse des enjeux de la mise en place du dispositif « Lycée 4.0 ». Les objectifs de la thèse sont donc (i) d’étudier l’acceptation du numérique, à travers les perceptions et les usages de l’ensemble des acteurs impliqués (lycéens, enseignants et parents d’élèves), ainsi que (ii) d’évaluer les effets du dispositif sur la dimension école-familles.

International audience; To the Editor-Gender inequality is prevalent in many countries and cultures, and it persists despite our awareness of it and the policies some countries have put in place to combat it. France, for example, offers significant opportunities to enable women to handle both career and personal life: it provides a social healthcare system that was ranked No. 1 by the World Health Organization in 2000, a legal framework promoting gender equality 1 , and relatively accessible and affordable childcare and scholastic infrastructure. Herein lies the paradox: despite France having a strong reputation for providing a favourable social and professional context, French women still lag behind French men in their careers. One of the main reasons gender inequality persists despite this supportive infrastructure is the perpetuation of implicit biases and gender stereotypes. These shape the way we behave, our ability to recognize unequal treatment, the willingness of disadvantaged individuals to speak up, and even the research conducted in institutions that have been raising awareness of gender inequalities in science since 2001 2,3

National audience

Over a decade ago, researchers published the first case of a patient who had been clinically unresponsive for years after traumatic brain injury (TBI) and demonstrated command following using motor imagery paradigms visualized by functional magnetic resonance imaging (fMRI) [1]. The term “cognitive motor dissociation” is gaining popularity to describe this scenario of an inability to behaviorally express preserved cognitive processes [2]. Alternative labels are covert or hidden consciousness and functional locked-in syndrome [3] (see Table 34.1). A flurry of subsequent studies using fMRI and functional electroencephalogram (fEEG) approaches explored the boundaries of human consciousness following brain injury. This growing body of knowledge is now being discussed in the lay press and is starting to affect clinical medicine, challenging the classical taxonomy of disorders of consciousness ([4] see Table 34.1). Until very recently, researchers have focused their attention on patients suffering from chronic disorders of consciousness and have generated estimates of cognitive motor dissociation of around 15% using convenience samples of these patients [5]. Detection of cognitive motor dissociation in the acute phase of brain injury may have prognostic significance as these patients are more likely to also recover behavioral command following and have better long-term functional outcomes.

International audience

International audience

Background Numerous studies have pointed out the need for better training of healthcare professionals in drug-drug interactions management in order to minimize adverse drugs reactions impacts on patients. The aim of this study was to evaluate the benefits of a blended learning strategy based on peer evaluation (PE) for teaching drug-drug interactions to undergraduate pharmacy students. Methods Third-year pharmacy students (n = 72) from the University of Limoges were involved in a hybrid teaching using the Moodle platform (2.9 version). After the theoretical lectures, an online activity was proposed to students. Each student submitted a report addressing a clinical case for peer evaluation. Students evaluated the pedagogical approach using an online survey. Quantitative benefits were assessed from students randomly assigned into two groups: PE in pharmacodynamics items (PE-PD) or PE in pharmacokinetics items (PE-PK). During this activity, three marks were given: one from peers for their evaluation work and two from teachers for oral group presentation of the clinical cases and for the final written examination. Statistics were performed using two-tailed unpaired t-test and significance was set for p Results Only a few students (n = 14, 20.6%) were aware of the peer evaluation principle and even less, only one student (n = 1, 1.5%), had already encountered it. Students considered that they benefited from this evaluation (n = 65, 95.6%); from their work being reviewed (n = 62, 91.2%) and that they participated in improving their classmates understanding (n = 59, 86.8%). Peers’ allocated marks were similar in the two PE groups (PE-PD = 17.4 ± 1.4; PE-PK = 17.3 ± 1.4). Teachers’ marks for oral presentation were significantly lower for pharmacodynamics than for pharmacokinetics items (PE-PD = 15.2 ± 1.2; PE-PK = 16.1 ± 2.1; p Conclusions Besides the fact that a major short-term quantitative improvement was not detected, our teaching approach was qualified as being a positive and stimulating learning tool by students.

International audience; Participants were instructed to reproduce a previously observed distance by travelling passively at a constant velocity into straight textured tunnels in a CAVE. The diameter of the tunnel into which participants travelled and the egocentric distance to be reproduced were manipulated. Participants' distance perception was sensitive to the tunnel's scale, distance being overestimated with the tunnel's diameter increase and underestimated with the tunnel's diameter decrease.