Special care in dentistry in France: Issues, current situation, outlook / Les soins spécifiques en odontologie en France : enjeux, état des lieux, perspectives

The question of oral health care and access to it for persons with disabilities is a key public health issue. This contribution describes the general landscape of access to oral health care for persons with disabilities since Law no.2005-102 of February 11, 2005, taking a broad approach that spans initial training and continuing education in the sector, the Romain Jacob charter, and the implementation of several networks. It also provides an analysis of the use of financial measures to incentivize the recognition of overtime spent providing care for persons with disabilities. The results of this study show that: considerable progress has been made in training; the missions of disability specialists must be redefined at the departmental level to enable these professionals to play their role; the enhanced financial recompense offered for this care is a step in the right direction but is insufficient to improve access to care for persons with disabilities; and, although care networks have proliferated, their future is uncertain given the precariousness of their funding. They remain, however, a system for providing care operating in parallel to mainstream care. While definite progress has been made over the past ten years, the Handifaction barometer shows that there is still much room for improvement as regards persons with disabilities' satisfaction with access to oral health care in France.

La question des soins buccodentaires et d'accès aux soins des personnes en situation de handicap est une question de santé publique primordiale. L'objectif est de décrire le paysage général de l'accès aux soins oraux des Personnes en situation de handicap depuis la loi du 11 février 2005. Un descriptif allant de la formation initiale à la formation continue en passant par l'engagement à appliquer la charte Romain Jacob et à la mise en place d'un certain nombre de réseaux est rapporté. Une analyse de l'utilisation des mesures pécuniaires incitatives à la prise en compte du temps supplémentaire de prise en soin des personnes handicapés est réalisé. Les résultats de ce descriptif montrent : Que de grands progrès ont été réalisés en matière de formation. Qu'une redéfinition des missions des référents handicap au niveau des ordres départementaux est nécessaire pour qu'ils puissent jouer leur rôle. Que la valorisation financière avec le supplément appliqué à la prise en charge est une avancée mais reste insuffisante pour améliorer l'accès aux soins des personnes en situation de handicap.Que les réseaux de soins se sont multipliés mais ont un avenir incertain compte tenu de la précarité de leur financement. Ils restent, cependant, un système de prise en charge parallèle à l'accès aux soins de droit commun. Si des progrès certains ont été constatés ces dix dernières années, le baromètre d'Handifaction reste très perfectible quant à la satisfaction des personnes en situation de handicap de l'accès aux soins buccodentaire sur le territoire.

Negative impact of urban habitat on immunity in the great tit Parus major.

Urban habitats are described as having an overall negative influence on many fitness-related traits in several bird species, but a vital function such as immunity remains poorly studied. The immune response is strongly linked to individual condition, which partly depends on resource availability and the parasitic context that often differ between urban and natural habitats. A difference between the immunity of populations dwelling in urban areas and populations from more natural habitats can, therefore, be hypothesized. We conducted a 2-year experimental study on great tits (Parus major) in urban and forest areas. We stimulated the constitutive immunity of nestlings and assessed both the inflammatory response by measuring the plasma levels of haptoglobin, an inflammatory marker, and its activation cost through the loss of body mass. In addition, we checked the nestlings for ectoparasites and assessed haemosporidian prevalence in adults. Nestlings from urban sites produced relatively less haptoglobin and lost more body mass than those from forest sites, which suggests that the activation of constitutive immunity is more costly for birds living in urban sites than for those living in the forest. We detected no ectoparasite in birds in both habitats. However, urban adults showed lower haemosporidian prevalence than forest ones, suggesting a reduced exposure to these parasites and their vectors in towns. Overall, our study provides evidence for an immune difference between urban and forest populations. Because immunity is crucial for organism fitness, it is of prime interest to identify causes and processes at the origin of this difference.

Reduced inflammation in expanding populations of a neotropical bird species.

The loss of regulating agents such as parasites is among the most important changes in biotic interactions experienced by populations established in newly colonized areas. Under a relaxed parasite pressure, individuals investing less in costly immune mechanisms might experience a selective advantage and become successful colonizers as they re-allocate resources to other fitness-related traits. Accordingly, a refinement of the evolution of increased competitive ability (EICA) hypothesis proposed that immunity of invasive populations has evolved toward a reduced investment in innate immunity, the most costly component of immunity, and an increased humoral immunity that is less costly. Biogeographical approaches comparing populations between native and expansion ranges are particularly relevant in exploring this issue, but remain very scarce. We conducted a biogeographical comparison between populations of Spectacled Thrush (Turdus nudigenis) from the native area (South America) and from the expansion range (Caribbean islands). First, we compared haemosporidian prevalence and circulating haptoglobin (an acute-phase protein produced during inflammation). Second, we challenged captive birds from both ranges with Escherichia coli lipopolysaccharides (LPS) and measured postchallenge haptoglobin production and body mass change. Birds from the expansion range showed lower haemosporidian prevalence and lower levels of haptoglobin than birds from the native range. In addition, the inflammation elicited by LPS injection and its associated cost in terms of body mass loss were lower in birds from the expansion range than in birds from the native range. In accordance with the enemy release hypothesis, our results suggest that range expansion is associated with a reduced infection risk. Our study also supports the hypothesis that individuals from newly established populations have evolved mechanisms to dampen the inflammatory response and are in accordance with one prediction of the refined EICA hypothesis, proposed to understand biological invasions.