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RésuméAu décours d’une grossesse, le système urinaire subit une importante adaptation physiologique qui pose fréquemment un défi clinique dans les soins aigus. En effet, la dilatation de la voie urinaire, signe cardinal de l’obstruction reste physiologique chez une majorité de femmes alors que la maladie lithiasique est en même temps favorisée par la grossesse. Cet article propose une revue structurée et pragmatique de cette situation particulière où les options diagnostiques comme thérapeutiques sont limitées.

Supplementary Fig S1, S2, S3

Preclinical data show that intravesical instillation of Ty21a/Vivotif, a commercial vaccine against typhoid fever, is an effective alternative option to standard Bacillus Calmette–Guérin (BCG) immunotherapy for non–muscle-invasive bladder cancer (NMIBC). Here, we characterized the inflammatory effects of Ty21a on the bladder and investigated the immune mechanisms underlying tumor regression toward the use of this bacterial vaccine in NMIBC patients. MB49 bladder tumor–bearing mice had significantly improved survival after intravesical instillations of Ty21a doses of 106 to 108 colony-forming units. By IHC and morphology, both BCG and Ty21a instillations were associated with bladder inflammation, which was decreased with the use of low, but effective doses of Ty21a. Flow-cytometry analysis showed a significant infiltration of T cells, natural killer (NK) cells, and myeloid cells, compared with controls, after a single dose of Ty21a, whereas this was only observed after multiple doses of BCG. The induced myeloid cells were predominantly neutrophils and Ly6C+CD103+ dendritic cells (DC), the latter being significantly more numerous after instillation of Ty21a than BCG. Ex vivo infection of human leukocytes with Ty21a, but not BCG, similarly significantly increased DC frequency. CD4+ and CD8+ T cells, but not NK cells nor neutrophils, were required for effective bladder tumor regression upon Ty21a treatment. Thus, the generation of antitumor adaptive immunity was identified as a key process underlying Ty21a-mediated treatment efficacy. Altogether, these results demonstrate mechanisms behind intravesical Ty21a therapy and suggest its potential as a safe and effective treatment for NMIBC patients.

Résumé. Tout le monde a connu l’incontinence, dès le plus jeune âge. Elle affecterait cependant encore 200 millions de personnes dans le monde à l’âge adulte. Cette pathologie du quotidien est relativement peu rapportée des patient(e)s, mais limite la vie sociale de façon parfois dramatique. Sous réserve d’un sous-diagnostic pertinent, l’incontinence urinaire est une pathologie traitable avec des résultats élevés. Cet article propose une revue de la sémiologie essentielle ainsi que des traitements actuels afin que tout clinicien confronté au problème adopte une prise en charge adéquate.

Reconstruction of the posterior lamella after eyelid tumor removal is challenging and not consensual. Tarsus is the most suitable graft, but is only available in small amounts. Herein, we aim to determine the most appropriate way to replace the tarsus by comparing the biomechanical, histological, and optical properties of five commonly used grafts.This study was conducted at the University hospital of Nice between June 2019 and June 2020. Five posterior lamella grafts (tarsus, conchal cartilage, sclera, hard palate, and dermis) were harvested in five fresh frozen cadavers. Biomechanical properties were assessed by tractometry. Collagen and elastin fibers were analyzed by using histological analysis and optical characterization with the second harmonic generation imaging.The mean Young's modulus was 8.92 MPa (range, 2.90-22.90 MPa), 1.05 MPa (range, 0.39-1.76 MPa), 8.72 MPa (range, 2.0-23.50 MPa), 2.57 MPa (range, 0.41-4.35 MPa), and 1.44 MPa (range, 0.71-2.30 MPa) for the tarsus, the conchal cartilage, the sclera, the hard palate mucosa, and the dermis, respectively. The mean tensile strength was 3 MPa (range, 1.70-6.88 MPa), 0.54 MPa (range, 0.13-0.79 MPa), 2.87 MPa (range, 1.23-5.40 MPa), 1.4 MPa (range, 0.21-2.40 MPa) and 1.0 MPa (range, 0.46-1.43 MPa) for the tarsus, the conchal cartilage, the sclera, the hard palate mucosa, and the dermis, respectively. Hard palate mucosa was the closest to the tarsus regarding the ratio of elastin and collagen fibers. The average second harmonic generation intensity was 221 arbitrary units (a.u.) (range, 165-362 a.u.), 182 a.u. (range, 35-259 a.u.), 369 a.u. (range, 206-533 a.u.), 108 a.u. (range, 34-208 a.u.), and 244 a.u. (range, 195-388 a.u.) for the tarsus, the conchal cartilage, the sclera, the hard palate mucosa, and the dermis, respectively. The hard palate mucosa and the dermis were the closest to the tarsus regarding the collagen fiber size and orientation, respectively.By attributing 2 points for each characteristic (biomechanical, histological, and optical), the hard palate mucosa and the sclera seem to be the most suitable grafts to replace the tarsus.The aim of this article was to assess the biomechanical, histological and optical characteristics of five of the most commonly used tarsal grafts; this may be helpful in decisions for clinical practice.

Urinary incontinence: a good diagnosis as a basis for treatment

Despite recent innovation, the clinical pathway in prostate cancer is not perfect. The indication to first and control biopsy, as well as treatment choice and adjuvant treatment are clinical scenarios in which diagnostic and prognostic biomarkers might assist in clinical decision making. Some emerging biomarkers have been validated in specific clinical scenarios. Nevertheless, their utility and cost effectiveness in the current clinical pathway is yet to be proven. The aim of this article is to present the current available evidence on the novel biomarkers and discuss their role for each stage of prostate cancer care.En dépit de nombreuses innovations, l’itinéraire clinique du cancer de la prostate reste à ce jour imparfait. Ainsi, l’indication à une première et une deuxième biopsie, le choix du traitement approprié et l’ajout d’un traitement adjuvant sont autant de situations où des biomarqueurs, diagnostiques comme pronostiques, pourraient améliorer des décisions parfois lourdes de conséquences. De nombreux biomarqueurs émergents, avec leurs caractéristiques propres, bénéficient déjà d’un certain degré de validation clinique dans des situations précises. Néanmoins, une évaluation prospective de leur performance et de leur intérêt médico-économique global reste essentielle. Nous proposons dans cet article un tour d’horizon de ces nouveaux outils, ce pour chaque étape dans la prise en charge d’un cancer de la prostate.

INTRODUCTION AND OBJECTIVE:Micro-ultrasound (micro-US) is a novel US-based imaging modality that allows real-time targeted prostate biopsies with mpMRI fusion. Its high resolution relying on a 29 M...

Although major improvements in surgical and anesthetic techniques occurred over the past 30 years, radical cystectomy (RC) remains burdened with high morbidity. Postoperative ileus is a concern in open RC, often resulting in prolonged length of stay and increased costs. Strategies to promote bowel function recovery, such as opioid-sparing anesthesia, pain management, early mobilization, oral feeding, and appropriate use of intravenous fluids, are in the forefront. The need for a multidisciplinary approach is also enlightened.

Preclinical data show that intravesical instillation of Ty21a/Vivotif, a commercial vaccine against typhoid fever, is an effective alternative option to standard Bacillus Calmette-Guérin (BCG) immunotherapy for non-muscle-invasive bladder cancer (NMIBC). Here, we characterized the inflammatory effects of Ty21a on the bladder and investigated the immune mechanisms underlying tumor regression toward the use of this bacterial vaccine in NMIBC patients. MB49 bladder tumor-bearing mice had significantly improved survival after intravesical instillations of Ty21a doses of 10 6 to 10 8 colony-forming units. By IHC and morphology, both BCG and Ty21a instillations were associated with bladder inflammation, which was decreased with the use of low, but effective doses of Ty21a. Flow-cytometry analysis showed a significant infiltration of T cells, natural killer (NK) cells, and myeloid cells, compared with controls, after a single dose of Ty21a, whereas this was only observed after multiple doses of BCG. The induced myeloid cells were predominantly neutrophils and Ly6C + CD103 + dendritic cells (DC), the latter being significantly more numerous after instillation of Ty21a than BCG. Ex vivo infection of human leukocytes with Ty21a, but not BCG, similarly significantly increased DC frequency. CD4 + and CD8 + T cells, but not NK cells nor neutrophils, were required for effective bladder tumor regression upon Ty21a treatment. Thus, the generation of antitumor adaptive immunity was identified as a key process underlying Ty21a-mediated treatment efficacy. Altogether, these results demonstrate mechanisms behind intravesical Ty21a therapy and suggest its potential as a safe and effective treatment for NMIBC patients.

Enhanced recovery after surgery (ERAS) is a multimodal concept aiming to reduce surgical stress and prevent postoperative complications. Once adapted to urologic patients in 2013, this protocol evolves continuously and many international centers have now implemented it. This article resumes ERAS key principles for general practitioners as they can have a significant impact on patient's optimization before surgery.Le protocole de réhabilitation améliorée après chirurgie est un concept de prise en charge multimodale visant à anticiper puis gérer de manière optimale le stress chirurgical inhérent à toute intervention. Adapté depuis 2013 à l’urologie, il évolue régulièrement et les centres internationaux qui appliquent ses principes sont toujours plus nombreux. Avant une chirurgie majeure, il existe un potentiel d’optimisation d’un patient auquel le généraliste peut participer activement. Cet article résume à l’attention d’un médecin généraliste les principaux points constituant cette démarche.

Antibiotics are most commonly prescribed for urinary bacterial infections. The purpose of this article is to review the most common infections of the genitourinary tract and to guide the choice of the most appropriate treatment. This choice depends also on the patients general state, local associated conditions and can range from observation to an emergency hospitalisation. Primary care physicians remain in the first line to take care of these patients but the urologists or the infectious disease specialists can provide some help in complex situations.Les infections urinaires bactériennes sont l’une des principales indications à la prescription d’antibiotiques. Le but de cet article est d’aider le praticien à reconnaître les diverses infections du tractus urogénital et à les traiter en utilisant les antibiotiques de façon appropriée. Le choix du traitement dépend aussi de l’état général du patient, de conditions locales associées et peut aller de l’abstention thérapeutique à l’hospitalisation en urgence. Le médecin de famille est en première ligne dans la prise en charge de ces pathologies fréquentes et l’urologue ou l’infectiologue peuvent apporter leur contribution dans les situations complexes.

In 1992, the United Nations listed Haiti among the countries that will face water scarcity by 2025. Haitian cities, in which water demand is already high, are increasingly exposed to population growth that significantly affects water and sanitation facilities, when they exist. These settlements suffer from the negative effects of increasing water demand on a daily basis. The most critical case is that of the metropolitan area of Port-au-Prince (MAPP). The consequences of the earthquake of January 12th, 2010 included the displacement of the population, the dislocation of the general drinking water supply system, the setting up of several make shift camps in the MAPP and the creation of new slum districts, the largest of which is Canaan, where more than 200 000 inhabitants now live. In a context of low coverage of safe drinking water and basic sanitation, it seems entirely appropriate to take a fresh look at water issues in slum development. The aim of this study is to analyze the supply of, and the demand for, water at Canaan. A field survey of water suppliers and vendors and other household surveys were conducted between February and April 2016. 240 water points, totaling an available volume of 2840 m 3 , were covered by the first survey. Regarding demand, a questionnaire was administered to 439 households spread over the six (6) localities composing Canaan. In 2007, only 0.23% from the population studied was living in Canaan. 31.44% of households moved into the area in 2010, just after the earthquake. The share of water in the budget of 90% of these households is higher than 5%. The selling price and frequency of supply remain the main variables responsible for spatial discrimination regarding the supply of the water market in Canaan. Future studies should use larger sample sizes to study the mechanisms capable of ensuring democratic water management in this area., En 1992, las Naciones Unidas pusieron en una lista a Haití entre los países que harán frente en 2025 a una escasez de agua importante. Las ciudades haitianas, cuya demanda en agua es ya elevada, se encuentran cada vez más expuestas a un crecimiento demográfico que afecta considerablemente las infraestructuras de agua y de saneamiento, cuando existen. Estos establecimientos humanos sufren a diario los efectos negativos de la demanda creciente en agua. El caso que aparece el más crítico, es el del Área metropolitana de Puerto Príncipe (AMPP). El terremoto del 12 de enero de 2010 tuvo, entre otras cosas, como consecuencias un desplazamiento de la población, la desarticulación de las redes y los servicios de agua potable y de saneamiento, la creación en la AMPP de varios campos improvisados y de nuevos barrios de chabolas, de los que uno de los más importantes es Canaán, en los que viven hoy más de 200,000 habitantes. En un contexto de cobertura débil en agua potable y en saneamiento de base, resulta oportuno echar una nueva mirada sobre la problemática del agua en los barrios precarios en formación. El objetivo de este estudio es analizar la oferta y la demanda en agua al nivel de Canaán. Una encuesta de terreno cerca de proveedores o vendedores de agua y otra cerca de los hogares han sido realizadas entre febrero y abril de 2016. 240 puntos de agua, totalizando un volumen disponible de 2840 m3, han sido cubiertos por la primera encuesta. En cuanto a la demanda, un cuestionario ha sido administrado a cerca de 439 hogares repartidos entre las seis (6) localidades que constituyen Canaán. En 2007, solamente el 0,23 % de la población estudiada vivía en Canaán. El 31.44 % de los hogares se instalaron en la zona en 2010, justo después del seísmo. El peso del agua en el presupuesto del 90 % de estos hogares es superior al 5 %.El precio de venta y la frecuencia de abastecimiento permanecen las principales variables que establecen una discriminación espacial al nivel de la oferta sobre el mercado del agua en Canaán. En el futuro, habrá que estudiar, sobre una muestra mucho más importante, los mecanismos que permitirán la implementación de una gestión democrática del agua en esta zona., En 1992, les Nations Unies ont listé Haïti parmi les pays qui feront face en 2025 à une importante pénurie d’eau. Les villes haïtiennes, dont la demande en eau est déjà élevée, se trouvent de plus en plus exposées à une croissance démographique qui affecte considérablement les infrastructures d’eau et d’assainissement, quand elles existent. Ces établissements humains subissent au quotidien les effets négatifs de la demande croissante en eau. Le cas qui apparaît le plus critique, est celui de l’Aire métropolitaine de Port-au-Prince (AMPP). Le tremblement de terre du 12 janvier 2010 a eu, entre autres, pour conséquences un déplacement de la population, la désarticulation des réseaux et services d’eau potable et d’assainissement, la création dans l’AMPP de plusieurs camps de fortune et de nouveaux bidonvilles, dont le plus important est Canaan, dans lequel vivent aujourd’hui plus de 200 000 habitants. Dans un contexte de faible couverture en eau potable et en assainissement de base, il apparaît opportun de jeter un nouveau regard sur la problématique de l’eau dans les bidonvilles en formation. L’objectif de cette étude est d’analyser l’offre et la demande en eau au niveau de Canaan. Une enquête de terrain auprès de fournisseurs ou vendeurs d’eau et une autre auprès des ménages ont été menées entre février et avril 2016. 240 points d’eau, totalisant un volume disponible de 2840 m3, ont été couverts par la première enquête. En ce qui concerne la demande, un questionnaire a été administré auprès de 439 ménages répartis entre les six (6) localités constituant Canaan. En 2007, seulement 0,23% de la population étudiée vivait à Canaan. 31,44% des ménages se sont installés dans la zone en 2010, juste après le séisme. Le poids de l’eau dans le budget de 90% de ces ménages est supérieur à 5%. Le prix de vente et la fréquence d’approvisionnement demeurent les principales variables établissant une discrimination spaciale au niveau de l’offre sur le marché de l’eau à Canaan. À l’avenir, il faudra étudier, sur un échantillon beaucoup plus important, les mécanismes permettant l’implémentationd’une gestion démocratique de l’eau dans cette zone.

Objectifs Les biopsies ciblees avec fusion d’image sont incontournables pour une stratification fiable du risque oncologique d’un cancer de la prostate presume localise a l’IRM. Nous avons evalue la performance de la micro-echographie (mUS) transrectale haute resolution 29 MHz (ExactVu) avec fusion embarquee pour guidage des biopsies. Methodes Inclusion retrospective de patients ayant subi des biopsies ciblees avec fusion IRM/mUS entre mai 2018 et mars 2019. Les biopsies ont ete effectuees par voie transrectale ou transperineale. Relecture systematique des IRM par un radiologue expert. L’echographie est enregistree pour relecture independante et les cibles comparees de maniere standardisee a l’IRM. Les biopsies de cibles sont completees de prelevements systematiques. Statistiquement, le cancer a ete considere cliniquement significatif a partir d’un score de Gleason individuel de 4 et/ou d’une longueur totale de cancer ≥ 10 mm. Resultats Dix-neuf patients ont ete exclus en raison d’imagerie incomplete ou de traitement anterieur. Cent quarante-huit patients, âge median 67 ans (60–71) et PSA median de 7 ng/mL (4,6–10,4) ont ete inclus. Quatre-vingt-deux (55 %) n’avaient jamais eu de biopsie, 24 (16 %) avaient eu de precedentes biopsies negatives, 34 (23 %) etaient sous surveillance active et 8 (5 %) subissaient une biopsie de stratification. Les scores PIRADS etaient 1–2 chez 38 (26 %) patients, 3 chez 6 (4 %) et 4–5 chez 104 (70 %). Un cancer significatif a ete identifie chez 79 patients (53 %), non significatif chez 14 (10 %) et aucun cancer chez 55 (37 %). Soixante-six (75 %) des 88 lesions posterieures PIRADS ≥ 3 etaient visibles en mUS et 36 lesions supplementaires sont detectees avec : 9 (25 %) cliniquement significatives, 8 (22 %) non significatives et 19 (53 %) faux positifs. Conclusion Notre etude suggere que les biopsies prostatiques guidees par mUS pourraient augmenter le taux de detection de cancers significatifs. En effet, la capsule posterieure est finement visualisee et la grande majorite des lesions sont identifiees. Ainsi et sous reserve d’etudes complementaires, le sous-diagnostic lie a une fusion imprecise pourrait etre minimise.

Ce texte examine la structure du chômage au Québec en termes de durée, de fréquence et de concentration du chômage. La méthodologie adoptée est celle développée par Clark et Summers pour les États-Unis, qui a été reprise par Hasan et De Broucker pour le Canada. Les résultats les plus frappants sont la proportion élevée du chômage causé par les longues périodes de chômage et la part relativement élevée du chômage qui se termine par des sorties de la population active. Ce dernier phénomène s’observe plus particulièrement chez les jeunes et chez les femmes., The purpose of this paper is to examine the structure of unemployment in Quebec, in terms of duration, frequency and concentration. The methodology adopted has been developed by Clark and Summers for the United States, and used by Hasan and De Broucker for Canada. The most striking results are: (i) the high concentration of unemployment, that is the high proportion of unemployment caused by relatively few periods of long duration, and (ii) the large extent to which unemployment ends with withdrawals from the labor force rather than with returns to employment. This last phenomenon applies especially to women and young people.

Après avoir résumé la problématique et la réglementation du temps supplémentaire au Québec, au Canada et dans d'autres pays, les auteurs présentent le phénomène du temps supplémentaire dans l'ensemble des branches d'activité au Canada, au Québec et en Ontario pour la période allant de 1975 à 1984., Overtime hours are a non-negligeable part of the total amount of hours worked in Canada, Quebec and Ontario. The potential for transforming overtime hours into full time jobs also appears to be significant. Nevertheless, there are very few studies on this subject in Canada, and specifically in Quebec and Ontario. This article seeks to remedy this gap, at least in part. The authors first describe the overall picture of overtime work in Quebec, Canada and some other western countries. They also summarize the studies done on this topic in Canada and in Quebec. The authors then look at overtime work in ail the industries in Canada, Quebec and Ontario for the period 1975-1984. The phenomenon is first dealt with globally and then according to status in the labor market, sex and profession. In conclusion, the possibilities for transforming overtime hours into full time jobs are examined. It appears that two aspects of the phenomenon under study seem to limit the possibilities for converting overtime hours into new full time jobs.First, when a worker doing some overtime is a part-time worker, he/she does more overtime than when he/she is a full-time worker. From the total of overtime hours that could be turned into full-time jobs, we first have to substract those which are done by part-time workers. It is clear that many part-time employees are willing to do a lot of overtime hours; it is also clear that many of them would prefer to be full-time workers. So, before it is possible to generate new full-time jobs out of overtime hours, we have to consider the obligation of converting a large number of part-time jobs into full-time jobs.Secondly, when a worker does some overtime, one out of three times, in Quebec as well as in Ontario, he/she holds a managerial position or he/she is a professional. This kind of overtime work is not one that is likely to be changed into full-time jobs.Therefore, we may well think that in order to generate new full-time jobs it is worth considering the restriction of overtime hours; but we must also remember that the project of reducing the number of overtime hours in order to create new full-time jobs is one burdened with its own limitations.

L'auteur analyse d'abord la réalité économique des licenciements collectifs relativement aux licenciements individuels et à l'emploi au Québec de 1979 à 1984. Face à la question du dédommagement des travailleurs touches par un licenciement collectif, l'auteur propose ensuite un critère de décision qui est en même temps un critère d'équité., This article analyses the economie reality of mass layoffs compared to individual layoffs in the Province of Quebec from 1979 to 1984. It arrives at the following conclusions:1. Layoffs follow a pronounced cyclical pattern. This is true regarding both the number of notices of mass layoff and the number of workers affected by them.2. From 85 to 90% of mass layoff notices affect less than 100 workers. Nevertheless, a significant number — between 45 and 111 annually — affect more than 100.3. Temporary layoffs and mass layoffs represent a relatively minor proportion of employment, and unemployment, as well as individual temporary and other layoffs — between 2.95% and 5.95% in the last case. The proportion, however, varies considerably in the economic cycle.4. The same observation can be made concerning mass and individual layoffs in the strict sense. 5. The number of complete closures involving mass layoffs constitutes a small proportion of the total number of bankruptcies — from 4.09 to 9.63%. Regarding the question of compensation of affected workers, the author proposes criteria to facilitate decision-making and establish the notion of fair play. They are based on the idea of the specifie link between the worker and the firm. The corresponding link between worker and firm is defined in the following terms:- the particuliarities of the techniques and procedures used by the firm, necessitating specifie on the job training for the worker;- the number of years of service with the same firm which contributes to making him «industry-specified»;- the distance of the firm from the major economic centres, limiting job choice;- the number of workers in the same firm; in cases of simultaneous layoffs of large numbers of workers, chances of finding employment quickly are reduced.The exact combination of means used to offset this problem — advance notice, compensation, retraining, relocation — varies according to the economy in question, particularly with reference to social choices.

Using a cross-sectional analysis of 67 manufacturing activities (three digit classification) in Quebec and considering 676 work stoppages which have occurred at the time of a contract renewal between 1980 and 1988, the authors' findings suggest that the "regime des decrets" has a significant impact on strike activity. Contrary to what has often been stated until now according to descriptive statistical methods the impact found is that the "regime" increases this activity. This increase has been found for both the equations using the incidence (number of strikes per thousand employees) and the intensity (number of working days lost per employee). Briefly stated, the measure of the strike and the explanatory variable taking into account the fact that a "decret" is in force in a manufacturing activity, are positively and significantly related, everything else being held constant.

The cost of unemployment may be broken down into two components: economic and social costs. This paper considers one aspect of social costs: the relation between unemployment and health. It makes use of panel data collected in a survey specifically designed to analyze this relation. These data enable us to construct a validated measure of mental health. Using a fixed effects model, the authors show that the risk of deterioration of mental health is greater among the unemployed. This may generate long-term effects leading to withdrawal from the labor market and greater dependency on social welfare programs.

Utilisant les données d'une enquête spéciale de Statistique Canada, l'auteur examine d'abord la dynamique du marché du travail au Québec comparativement à celle du Canada et de l'Ontario. Il étudie ensuite la situation spécifique au Québec en se concentrant sur les travailleurs déplacés et recyclés., In this paper, we examine the dynamics of the labour market, and more precisely the dynamics of unemployment in Quebec relative to Ontario and the whole of Canada.We first find that if it is true that there exists an important fluidity in the labour market, that fluidity is not sufficient to rapidly solve the unemployment problem. Using the data of a special Statistics Canada survey we then look at unemployment in Quebec, Ontario and Canada from a dynamic point of view. From that perspective, unemployment in Quebec seems even more dramatic than the result of conventional static analysis. Whatever the aspect we concentrate upon the proportion of workers who have lost a full time job and who have not been recalled by the same employer, the proportion of those who have not found a new job, the proportion of those who have not found a new full time job, the proportion of those who have got off the labour force, the proportion of those who have been looking for a full time job for more than six months, the score we get for Quebec is much worse than the one we get, comparing to Ontario and Canada, in a conventional static analysis.We also examine some aspects of the job search process, in Quebec alone. We calculate a «risk of losing a job» rate, a «chance of finding a job» rate and a ranking for some specifie groups according to sex, age, education level and industry. Differences appear to be important. Maies are ranked higher than females; the younger higher than the older; the more educated higher than the less educated and service industries higher than manufacturing industries.The analysis of these differences brings us to the conclusion that due to some special important changes in the market, the free trade agreement for example, some groups would suffer deeply.We then look at one particular manpower program: the training and retraining policy. Only 5% to 6% of the target population get services. It is really not much. On the other hand, we know that employment promotion expenditures are less in Canada than in many other industrialized countries. These two facts, taken together, are for us a convincing argument that training and retraining policies should be improved. This conclusion, however important it may be, should not make us forget the sources of unemployment other than the one analyzed here: unemployment due to a qualitative disequilibrium between demand and supply. The other sources of unemployment are really there in Quebec. We must continue to analyze them and fight them.

International audience; In 1992, the United Nations listed Haiti among the countries that will face water scarcity by 2025. Haitian cities, in which water demand is already high, are increasingly exposed to population growth that significantly affects water and sanitation facilities, when they exist. These settlements suffer from the negative effects of increasing water demand on a daily basis. The most critical case is that of the metropolitan area of Port-au-Prince (MAPP). The consequences of the earthquake of January 12th, 2010 included the displacement of the population, the dislocation of the general drinking water supply system, the setting up of several make shift camps in the MAPP and the creation of new slum districts, the largest of which is Canaan, where more than 200 000 inhabitants now live. In a context of low coverage of safe drinking water and basic sanitation, it seems entirely appropriate to take a fresh look at water issues in slum development. The aim of this study is to analyze the supply of, and the demand for, water at Canaan. A field survey of water suppliers and vendors and other household surveys were conducted between February and April 2016. 240 water points, totaling an available volume of 2840 m 3 , were covered by the first survey. Regarding demand, a questionnaire was administered to 439 households spread over the six (6) localities composing Canaan. In 2007, only 0.23% from the population studied was living in Canaan. 31.44% of households moved into the area in 2010, just after the earthquake. The share of water in the budget of 90% of these households is higher than 5%. The selling price and frequency of supply remain the main variables responsible for spatial discrimination regarding the supply of the water market in Canaan. Future studies should use larger sample sizes to study the mechanisms capable of ensuring democratic water management in this area.; En 1992, las Naciones Unidas pusieron en una lista a Haití entre los países que harán frente en 2025 a una escasez de agua importante. Las ciudades haitianas, cuya demanda en agua es ya elevada, se encuentran cada vez más expuestas a un crecimiento demográfico que afecta considerablemente las infraestructuras de agua y de saneamiento, cuando existen. Estos establecimientos humanos sufren a diario los efectos negativos de la demanda creciente en agua. El caso que aparece el más crítico, es el del Área metropolitana de Puerto Príncipe (AMPP). El terremoto del 12 de enero de 2010 tuvo, entre otras cosas, como consecuencias un desplazamiento de la población, la desarticulación de las redes y los servicios de agua potable y de saneamiento, la creación en la AMPP de varios campos improvisados y de nuevos barrios de chabolas, de los que uno de los más importantes es Canaán, en los que viven hoy más de 200,000 habitantes. En un contexto de cobertura débil en agua potable y en saneamiento de base, resulta oportuno echar una nueva mirada sobre la problemática del agua en los barrios precarios en formación. El objetivo de este estudio es analizar la oferta y la demanda en agua al nivel de Canaán. Una encuesta de terreno cerca de proveedores o vendedores de agua y otra cerca de los hogares han sido realizadas entre febrero y abril de 2016. 240 puntos de agua, totalizando un volumen disponible de 2840 m3, han sido cubiertos por la primera encuesta. En cuanto a la demanda, un cuestionario ha sido administrado a cerca de 439 hogares repartidos entre las seis (6) localidades que constituyen Canaán. En 2007, solamente el 0,23 % de la población estudiada vivía en Canaán. El 31.44 % de los hogares se instalaron en la zona en 2010, justo después del seísmo. El peso del agua en el presupuesto del 90 % de estos hogares es superior al 5 %.El precio de venta y la frecuencia de abastecimiento permanecen las principales variables que establecen una discriminación espacial al nivel de la oferta sobre el mercado del agua en Canaán. En el futuro, habrá que estudiar, sobre una muestra mucho más importante, los mecanismos que permitirán la implementación de una gestión democrática del agua en esta zona.; En 1992, les Nations Unies ont listé Haïti parmi les pays qui feront face en 2025 à une importante pénurie d’eau. Les villes haïtiennes, dont la demande en eau est déjà élevée, se trouvent de plus en plus exposées à une croissance démographique qui affecte considérablement les infrastructures d’eau et d’assainissement, quand elles existent. Ces établissements humains subissent au quotidien les effets négatifs de la demande croissante en eau. Le cas qui apparaît le plus critique, est celui de l’Aire métropolitaine de Port-au-Prince (AMPP). Le tremblement de terre du 12 janvier 2010 a eu, entre autres, pour conséquences un déplacement de la population, la désarticulation des réseaux et services d’eau potable et d’assainissement, la création dans l’AMPP de plusieurs camps de fortune et de nouveaux bidonvilles, dont le plus important est Canaan, dans lequel vivent aujourd’hui plus de 200 000 habitants. Dans un contexte de faible couverture en eau potable et en assainissement de base, il apparaît opportun de jeter un nouveau regard sur la problématique de l’eau dans les bidonvilles en formation. L’objectif de cette étude est d’analyser l’offre et la demande en eau au niveau de Canaan. Une enquête de terrain auprès de fournisseurs ou vendeurs d’eau et une autre auprès des ménages ont été menées entre février et avril 2016. 240 points d’eau, totalisant un volume disponible de 2840 m3, ont été couverts par la première enquête. En ce qui concerne la demande, un questionnaire a été administré auprès de 439 ménages répartis entre les six (6) localités constituant Canaan. En 2007, seulement 0,23% de la population étudiée vivait à Canaan. 31,44% des ménages se sont installés dans la zone en 2010, juste après le séisme. Le poids de l’eau dans le budget de 90% de ces ménages est supérieur à 5%. Le prix de vente et la fréquence d’approvisionnement demeurent les principales variables établissant une discrimination spaciale au niveau de l’offre sur le marché de l’eau à Canaan. À l’avenir, il faudra étudier, sur un échantillon beaucoup plus important, les mécanismes permettant l’implémentationd’une gestion démocratique de l’eau dans cette zone.