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RésuméLa gynécomastie est fréquemment retrouvée dans la pratique clinique de l’urologue ou du médecin généraliste. D’un point de vue physiopathologique, elle résulte d’un déséquilibre entre la concentration des œstrogènes et des androgènes. De multiples pathologies et traitements peuvent amener à cette perte d’équilibre. Il est important pour le clinicien de reconnaitre les signes de danger qui doivent faire suspecter une néoplasie maligne primaire du tissus mammaire ou secondaire ayant amené à la gynécomastie. Un bilan biologique de base permet le plus souvent de trouver la cause de la gynécomastie. Le traitement est le plus souvent sa cause. Pour certain cas particulier un traitement par le tamoxifène ou la radiothérapie peut être proposé. La chirurgie intervient lors de l’échec du traitement conservateur.

International audience; O artigo focaliza o crescimento do bairro Demétria, em Botucatu/SP, local de nascimento de uma importante iniciativa brasileira em favor da agricultura biodinâmica, braço da filosofia antroposófica. A análise se apoia na teoria das justificações, a partir da qual foi concebida a metodologia de pesquisa. Nesta ótica, a noção de justiça ecológica foi particularmente mobilizada. Com efeito, é possível considerar que as mudanças no bairro, com a instalação de muitos residentes e com grande conversão no uso do solo, enfraquecem a perspectiva de construção de um mundo justo e ecológico, com inspiração na antroposofia. Todavia, as forças de resistência local, diante de uma mutação desestruturante dos ideais fundadores do bairro, procuram inclusive difundir propostas assentadas em valores ecológicos para além das fronteiras do bairro, com êxito limitado.

Commencees il y a plus d’un siecle, les collections d’ethnobotanique du Museum sont directement liees a l’origine et l’evolution de son laboratoire d’ethnobotanique. Elles sont constituees de plantes utiles, connues, nommees et utilisees par les societes humaines de diverses aires geographiques, et comptent pres de 100 000 items. On en retrace ici la mise en place et les principes qui ont guide leur realisation, puis on en presentera une description precise avant de conclure sur leur evolutio...

ObjectiveThis secondary analysis of data of a randomized controlled trial (RCT) retrospectively investigated the performance of pulse oximetry in identifying children with severe illnesses, with and without respiratory signs/symptoms, in a cohort of children followed for morbid episodes in an intervention trial assessing the efficacy of Intermittent Preventive Treatment for malaria in infants (IPTi) in Papua New Guinea (PNG) from June 2006 to May 2010.SettingThe IPTi study was conducted in a paediatric population visiting two health centres on the north coast of PNG in the Mugil area of the Sumkar District.ParticipantsA total of 669 children visited the clinic and a total of 1921 illness episodes were recorded. Inclusion criteria were: age between 3 and 27 months, full clinical record (signs/symptoms) and pulse oximetry used systematically to assess sick children at all visits. Children were excluded if they visited the clinic in the previous 14 days.OutcomesThe outcome measures were severe illness, severe pneumonia, pneumonia, defined by the Integrated Management of Childhood Illness (IMCI) definitions, and hospitalization.ResultsOut of 1921 illness episodes, 1663 fulfilled the inclusion criteria. A total of 139 severe illnesses were identified, of which 93 were severe pneumonia. The ROC curves of pulse oximetry (continuous variable) showed an AUC of 0.63, 0.68 and 0.65 for prediction of severe illness, severe pneumonia and hospitalization, respectively. Pulse oximetry allowed better discrimination between severe and non-severe illness, severe and non-severe pneumonia, admitted and non-admitted patients, in children ≤12-months of age relative to older patients. For the threshold of peripheral arterial oxygen saturation ≤ 94% measured by pulse oximetry (SpO2), unadjusted odds ratios for severe illness, severe pneumonia and hospitalization were 6.1 (95% Confidence Interval (CI) 3.9-9.8), 8.5 (4.9-14.6) and 5.9 (3.4-10.3), respectively.ConclusionPulse oximetry was helpful in identifying children with severe illness in outpatient facilities in PNG. A SpO2 of 94% seems the most discriminative threshold. Considering its affordability and ease of use, pulse oximetry could be a valuable additional tool assisting the decision to admit for treatment.

Este artigo analisa as trajetórias de conversão para agricultura orgânica de agricultores familiares localizados na região metropolitana de São Paulo durante os anos 1990 e 2000. Esta conversão ocorreu sob o impulso inicial de indivíduos ligados ao movimento da teologia da libertação e depois da estruturação posterior de um mercado regional em torno da grande distribuição. O texto mostra como a integração desses agricultores em um sistema de mercado regido por lógicas capitalistas foi acompanhada, localmente, por uma profissionalização da agricultura e pela implantação de lógicas e estruturas empresariais. Mostra também como estas dinâmicas de modernização ecológica, embora contribuindo para a geração de uma nova elite rural e de novas formas de desigualdade social, parecem ao mesmo tempo poder contribuir para a manutenção da agricultura em um contexto de forte pressão urbana, para o retorno dos jovens a esta atividade e para a construção de territórios de qualidade ecológica. Nesse sentido, ele indaga se existiriam contextos nos quais a modernização ecológica seria um compromisso aceito por defensores de uma alternativa mais radical? Qualquer que seja a resposta a essa pergunta, a demonstração aqui proposta sublinha a importância de reintegrar a análise das trajetórias ecológicas agrícolas em um estudo mais geral das mudanças sociais, particularmente em seus componentes locais.AbstractThis paper analyzes small farmers’ trajectories in converting to organic farming in the metropolitan region of São Paulo during the 1990s and 2000s. The conversion occurred under the initial push of individuals connected the movement of the Theology of Liberation and after the structuring of a regional market around large-scale distribution. The paper shows how the integration of these farmers in a market system ruled by capitalist logic was accompanied, at the local level, by the professionalization of agriculture and by the implantation of corporate structures and logic. It also shows how these ecologic modernization dynamics, while contributing to the creation of a new rural elite and new forms of social inequality, seem to also be able to contribute to the maintenance of farming in a context of strong urban pressure, to the return ofyoung people to farming, and the construction of territories of ecologic quality.In this sense, it questions whether contexts exist in which ecologic modernization would be a compromise accepted by defenders of more radical alternatives? Whichever the answer to this question, the answer we propose underlines the importance of reintegrating the analysis of the ecologic farming trajectories to a broader study of social changes, mainly in its local components.

Du point de vue socio-environnemental, la situation au Brésil peut être considérée aujourd’hui comme catastrophique. Cependant, les difficultés ne sont pas nouvelles. Le modèle « social-développementaliste » déployé sous Luiz Inácio Lula da Silva lui-même prête largement le flan à la critique. Mêlant des politiques macroéconomiques néolibérales à un interventionnisme d’État, il a généré des situations hautement paradoxales, créant des tensions importantes entre développement et protection de l’environnement, mais aussi entre intérêt national et reconnaissance des droits de certaines minorités. La situation s’est nettement dégradée sous le premier mandat de Dilma Rousseff, puis avec le coup d’État parlementaire de 2016, qui a fait céder les derniers remparts. Les élites conservatrices ont défait la fragile régulation socio-environnementale pour imposer leurs intérêts par la force. Violence et criminalisation des opposants s’affirment comme modes de régulation d’un État dont la dérive policière est particulièrement inquiétante. De uma perspectiva socioambiental a situação do Brasil pode ser considerada hoje como catastrófica. Contudo, os elementos que caracterizam essa situação não são novos, pois, estão em parte presentes no governo de tipo « social-desenvolvimentista » efetivado a partir do governo Luiz Inácio Lula da Silva. Esse governo, que mesclou políticas macroeconômicas neoliberais com um intervencionismo estatal, gerou situações paradoxais que estabeleceram tensões importantes entre questões como desenvolvimento e proteção ambiental, interesse nacional e direitos de minorias. Situação que se agravou no primeito mandato de Dilma Roussef e que, após o golpe de 2016, se aprofundou de forma mais drástica ainda, com investidas das elites conservadoras na descontrução da regulação socioambiental vigente, de maneira a impor seus interesses pela força. Ações de criminalização e utilização da violência contra oponentes se tornarão o padrão de atuação de um Estado que passa a tratar a questão socioambiental como caso de polícia. From a socio-environmental perspective, the situation in Brazil today may be said to be disastrous. Yet, these difficulties are not new. The “social-developmentalist” model implemented under Lula’s presidency is also vulnerable to critique. By combining neo-liberal macroeconomic policies and state interventionism, it has produced contradictory situations, and strong tensions between development and environmental protection, and national interest and rights of minorities. Things worsened during the first mandate of President Dilma Rousseff, and even more so after the 2016 parliamentary coup. Conservative elites are undoing environmental legislation to defend their interests. Violence and criminalization of opponents is becoming a new mode of state regulation.

L’environnement s’est impose comme un probleme majeur de societe. Au-dela des arenes et institutions qui tentent de le prendre en charge a l’echelle globale, il penetre tous les jours un peu plus le quotidien de la cite et des affaires humaines (Vertovec & Posey 2003 ; Poirot-Delpech & Raineau 2012). Il contribue a de nombreuses controverses, conduit a la production de lois, de politiques publiques, de normes. Il est a l’origine d’une reformulation des theories et des pratiques economiques, s...

Quality of life (QoL) is of great importance to patients with schizophrenia and their families. Although the use of QoL measures may contribute to better adherence to therapeutic interventions, more satisfaction with care, improved health outcomes and reduction of health costs, QoL assessment remains underutilized in clinical practice. In this review, the authors propose a reflection on the limitations and lack of impact of QoL measures in clinical care. Our argument is based on three challenges regarding conceptual aspects and metrics, use and limits and the usefulness of measuring QoL. For each challenge, the authors have suggested pragmatic proposals and new research directions to promote the use of QoL measures in the future. These avenues of research involve a shared responsibility between QoL researchers, the medical community and decision makers. Close collaboration between all parties is necessary to promote the use of QoL measures in schizophrenia.

Nous abordons le sujet sur la base des recherches sur les natures urbaines lancées au Muséum dans les années 1990, concrétisées par un colloque (1996), deux journées d’études et deux opérations de recherche au sein de l’UMR Éco-Anthropologie et Ethnobiologie, le tout chevillé à des enseignements. La problématique initiale était celle des « villes naturalisées », qui a été commuée en « villes vivrières ». L’idée majeure qui se dégage de cette réflexion collective est l’enchaînement des représe...

International audience; PURPOSE: Recent studies have demonstrated that various diseases states (e.g., schizophrenia, Alzheimer's disease) and events (e.g., a stroke) alter a person's perception of their physical and mental status. Most often this involves alterations in a person's metacognitive capabilities, and this can question the conceptual model of quality of life (QoL) based on a "perspectivist" approach. METHODS: Using the example of schizophrenia, we applied a philosophical model, developed by Griffin, to deal with this potential threat to the validity of QoL assessment. RESULTS: Patients with schizophrenia are at risk for being impaired in their ability to assess their QoL. We hypothesise that metacognition (i.e., the ability to attribute mental states in terms of beliefs and goals to one's self and others) is a formal condition to assess QoL. This particular skill is important because self-reflection is necessary for making a qualitative judgment. A link between this psychological concept and the philosophical concept of reflexivity may be established. We propose a conceptual approach to QoL that takes into account the patient's reflexivity. This approach is derived from Griffin's theory based on the list of "prudential values" and the satisfaction of the informed desires of the individual. CONCLUSION: The ability of patients to evaluate and value their life should be considered to enrich the concept of QoL. The approach derived from Griffin's theory might constitute a new avenue for QoL research.

Depuis le début des années 90, la contractualisation s’est imposée comme l’une des principales modalités de réponse aux enjeux de gestion de la biodiversité dans le Parc national des Cévennes. Elle est non seulement considéré comme contribuant à une « bonne gouvernance » de la nature mais également présentée comme un levier pour la sensibilisation et l’engagement des populations locales en faveur de la gestion de la biodiversité. Cependant, comme nous le montrons ici à partir du cas du causse Méjean, vingt-cinq années de gestion contractuelle n’ont guère fait entrer la biodiversité dans le quotidien des éleveurs. Si tel est le cas, c’est d’une part que cette dernière reste avant tout l’expression d’une forme technocratique de la nature, qu’elle s’est imposée aux éleveurs à travers une grammaire normée, incapable de s’intégrer à leur environnement « vécu ». Mais si tel est le cas, c’est d’autre part que la gestion contractuelle telle qu’elle se présente localement n’est qu’une forme pervertie du principe de libre manifestation des intérêts de chacun qu’elle est censée incarner. En effet, dans les conditions actuelles de l’exercice de leur métier, les éleveurs ne sont guère « libres » de souscrire ces contrats. Cette tentative d’imposition d’éléments de nature, qui implique une re-signification profonde du territoire vécu des éleveurs et passe par des logiques contractuelles dévoyées, concoure ainsi à un faible niveau d’appropriation des enjeux de protection de la nature par les éleveurs et à la fragilité d’un dispositif de conservation toujours largement dominé par des rapports conflictuels entre ces derniers et les représentants du Parc national. Since the early 90’s “contractualisation” is seen as one of the major tools for biodiversity conservation in the Parc national des Cévennes (France). “Contractualisation” is considered to contribute to a better governance of nature. Furthermore, it is supposed to enhance the farmers’ sensitiveness and commitment toward biodiversity management stakes. However, it appears that since the “contractual turn” that occurred 25 years ago within the park, biodiversity didn’t find his way within the hearts and souls of the sheep breeders living in this place. Our explanation for this failure is that, one the one hand, biodiversity remains a technocratic and highly normative way of designing nature elements and natural processes that doesn’t fit in the breeders “lived environment”. On the other hand, we consider this failure as the result of a “contractual turn” that is disconnected with the principle of freedom that is theoretically at the heart of any contractual form. Indeed, in a context where almost a third of the breeder’s incomes come from such contracts, signing these latter is perceived less as a matter of choice than of necessity. The overall result is a low level of appropriation of the (local) stakes regarding nature conservation by the breeders and a co-management of biodiversity that is precarious and still strongly based on conflictual relations.

Quelles sont les consequences d’un processus conjoint de modernisation ecologique et l’evolution des modes de vie dans les campagnes pour l’agriculture familiale au Bresil ? Comment les changements dans la production agricole interagissent-ils avec les changements dans les configurations des familles rurales du Bresil d’aujourd’hui, et comment cela affectet-il la dynamique de la petite agriculture ? Telles sont les principales questions auxquelles cet article cherche a apporter des reponses a partir d’une etude de cas sur l’emergence et la croissance de l’agriculture biologique dans un « quartier rural » situe a proximite de Sao Paulo, pour tenter d’evaluer la contribution de la modernisation ecologique au maintien de l’activite agricole dans des zones rurales souffrant d’une forte pression urbaine. Cet article montre que la modernisation ecologique peut contribuer au maintien d’une agriculture dynamique en permettant a tous les membres de la famille, independamment de leur sexe, âge ou niveau de qualification, de trouver leur place dans des activites agricoles qui passent d’un statut familial a un statut entrepreneurial.

From 2000 to 2010, the production of organic vegetables in the Ile-de-France region grew principaly according to a community supported agriculture scheme, within the frame of a regional network called AMAP-IdF. This network unfolds through partnerships that transcends the boundaries historically established in the french agricultural field and highlights the key role played by the territorialisation of public policies in the mutations currently at work in this field. This case-study show that developing alternative agrifood systems remains problematic in an agricultural field within which organisations created during the modernization era are still dominating. Meanwhile it illustrates how the penetration of the food fabric by urban dwellers helps expressing latent identity mutations within the agricultural social world itself., Le développement du maraîchage Biologique en Ile-de-France s'appuie principalement, en ce début de XXIe siècle, sur un système d'acteurs bâti autour du réseau régional AMAP. Ce système d'acteurs se déploie à travers un réseau partenarial qui transcende les cloisonnements historiquement institués dans le champ agricole et souligne le rôle clé joué par la territorialisation des politiques publiques dans les recompositions à l'oeuvre dans ce champ. Ce cas montre comment le déploiement de modèles agricoles et agro-alimentaires critiques reste aujourd'hui difficile dans un champ en forte tension, toujours dominé par les héritiers du système de cogestion. Il illustre également une forme de réappropriation de la fabrique agricole - et des espaces de production - par des individus d'origine urbaine, tout en ouvrant la voie à l'expression de mutations identitaires latentes dans le monde agricole lui-même.

International audience; The Brazilian organic food sector has experienced important growth during the last two decades. Brazilian smallholders, however, are facing huge challenges to enter and benefit from this growth in a sustainable way. Combining the lens of New Institutional Economics and socio-anthropology, we analyze six experiences of Brazilian smallholders who converted to organics in the 1990s'. Three different food systems are featured in this analysis: an alternative food system, which is strongly interwoven with the Brazilian Agro-ecological movement and two commercial food procurement systems oriented towards domestic and an export markets driven mainly by supermarket chains. The analytical focus was on 1) the governance of these food systems, 2) the constraints farmers are facing within these food systems and, 3) the benefits that they can expect from market inclusion. We highlighted the roles that NGOs, Faith-based organizations and public-related agencies play in supporting the inclusion of smallholders into all three food systems. We confirmed the arguments in support of pursuing the agroecological development based model in Brazil, but underlined that there is a critical lack of support for farmers included in the commercial market-oriented food systems. Such a lack is even more critical as the food systems driven by expanding supermarket chains are characterized by strong asymmetric power relations at the expense of smallholders. Considering the reluctance of NGOs and Faith-based organizations to support these farmers, we call for efforts to be made to provide a policy framework to enable public-related entities to secure sustainable inclusion into these systems and exit strategies for those experiencing exclusion from these highly competitive food systems.

Ete 1940. Dans un pays assomme par la debâcle, les premieres manifestations du refus de l’occupant s’ebauchent dans Paris, en particulier au musee de l’Homme. Des noyaux de resistance naissent. Par contacts successifs, une nebuleuse rassemblant des groupes divers se developpe et se lance dans des actions variees : propagande, evasion, renseignement. Disseminee geographiquement, socialement et ideologiquement variee, cette desobeissance pionniere est rapidement en butte a une repression feroce. Ses principaux chefs de file, le linguiste Boris Vilde et l’anthropologue Anatole Lewitsky, sont juges et executes en fevrier 1942. Comment cette premiere Resistance s’est-elle structuree ? Quelles ont ete les motivations et les profils de ses membres ? La repression a-t-elle irremediablement decime les groupes qu’ils avaient mis sur pied ? Comment enfin l’histoire et la memoire de ces ephemeres constructions se sont-elles articulees de 1942 a nos jours ? Dans ce livre, Julien Blanc presente a la fois l’histoire singuliere d’une organisation de Resistance et un essai sur les premieres formes de la desobeissance en zone occupee.

International audience

Nous montrons ici comment les connaissances et les representations qu’ont des eleveurs du causse Mejan de leurs pâturages se construisent dans les rapports etroits et « situes » qu’ils entretiennent avec leurs animaux et le milieu naturel. Les eleveurs « apprennent le milieu » en grande partie a travers l’observation des comportements au pâturage de leurs animaux et considerent leurs « parcours » a la fois en tant qu’espace de ressources et espace de vie pour ces derniers. L’engagement affectif et corporel avec les processus vivants, qui operent a travers un quotidien partage avec les animaux et les milieux ecologiques, constitue un aspect essentiel dans la construction de savoirs et de savoir-faire en matiere d’elevage. Nous soutenons que ces aspects doivent etre mieux pris en compte afin d’ameliorer la qualite du dialogue entre scientifiques, encadrement agricole et eleveurs.

The expansion of the organic sector in Brazil is seen as a leverage for the social emancipation of the small family farmers. Next to the traditional alternatives circuits of organic food and farming, new powerful capitalistic actors, such as supermarket chains, are rapidly entering the Brazilian organic arena. Can family farming benefit from the development of these “conventional” commercialisation circuits in the organic sector? Research undertaken in 2007, in a green belt rural community of Sao Paulo, shows how family farmers may have benefited from the implication of large retail chains in the organic sector and how an economically and ecologically outstanding agriculture may arise from these circumstances. However, we highlight the crucial role played by social regulation: only strong solidarity between farmers and the implication of technicians, militants and researchers in the process made it possible to counter the negative effects of the liberal logic governing the development of organic farming via the major retailers. Still, as tougher competition is expected on the regional organic market, the development of short supply chains involving “committed” consumers and the broader integration of the local farmers in networks of organic militancy appear crucial. It would guarantee a continuous enhancement of the local human and social capital, reinforce an emerging process of internal conversion and allow for a stronger social regulation of the future local development pattern.

Le « reseau du musee de l’Homme », organisation emblematique des debuts de la Resistance en zone occupee, semble bien connu. Une etude precise permet pourtant de souligner la richesse de ses composantes, la variete de ses activites ou encore l’originalite de son fonctionnement, loin de l’image d’Epinal qui s’est imposee. A travers le cas d’ecole du musee de l’Homme, ce sont quelques-unes des specificites de cette premiere desobeissance qui sont ici mises en lu-miere.