nurse`s guide - L`Oréal Paris
Transcription
nurse`s guide - L`Oréal Paris
NURSE’S GUIDE Grades 4-5-6 Program Program offered by Important Message from Mission UV Table of Contents We would like to thank the following individuals and organizations for their invaluable assistance with the educational and/or scientific content of this program: This documentation will confirm the importance of your mission and provide you with more detailed information. Thank you for sharing it with your class. Important Message from Mission UV 1 Introduction to the Program 2 Key Facts About a Serious Situation Design and Production Youville Creative Community www.youvillecc.com 1.0 Mission UV Program 3 References 1.1 Sun—Background Reading 4 • Skin cancer is the most widespread form of cancer. • The incidence of skin cancer is now 30% higher than it was ten years ago. • In 2009, approximately 80,100 people found out they had skin cancer. • More than 940 of them will die from it. 1.2 Skin—Background Reading 5 Critical Mission UV Information Canadian Cancer Society Health Canada This program is offered by L’Oréal Canada Inc., manufacturer of Ombrelle® sunscreens (L’Oréal/Suncare Research). These products were developed with the assistance of Canadian dermatologists. Demand for sunscreens has never been greater. The Canadian Dermatology Association recognizes that the regular use of Ombrelle® sun protection helps protect skin from sunburns and can reduce the risk of long-term damage due to sun exposure. Ombrelle® (L’Oréal/Suncare Research) is a registered trademark of L’Oréal Canada Inc. 1.3 Sunscreens—Background Reading 6-7 1.4 Four Types of Protection—Background Reading 8-9 Important Message 10 2.0 Sunsmart Tips 11 2.1 Sunsmart Tips for the Summer 12-13 2.2 About Ombrelle 14 2.3 Ombrelle and Education 15 2.4 Ombrelle Product Lines 16 Supporting Materials There are three types of skin cancer. The two most common forms are basal cell carcinoma and squamous cell carcinoma, which account for 90% of cases. These types of cancer develop on areas of the body that are regularly exposed to the sun, such as the face, neck, forearms and back of hands. They are the result of repeated exposure to the sun with insufficient protection. People who have spent a lot of time outdoors during their lives—farmers, for example—are more vulnerable to skin cancer. If treated relatively early, these types of cancer are rarely fatal, but they can leave significant scars. However, one alarming fact is that melanoma is increasingly diagnosed in younger people. This type of cancer is more likely to be cured if detected and treated early. When you know that the damage caused by ultraviolet (UV) rays increases with each exposure, it’s easy to see why children have to be very careful and protect themselves properly from the sun. It’s all the more important, because people generally accumulate between 50% and 80% of their lifetime exposure to UV rays before the age of 18. One thing is for sure… you are on a highly strategic mission to protect children. The other type of skin cancer is melanoma. It accounts for one in 20 cases of cancer and is extremely dangerous. Melanoma begins in the cells of the skin that produce pigmentation. Melanoma causes the majority of skin cancer-related deaths. Fortunately, this form is less common. 17 Skin Cancer Facts and Figures SKIN CANCER TYPES Cases diagnosed in Canada in 2009 Basal cell carcinoma Squamous cell carcinoma Melanoma More than 75,100 More than 5,000 Treatment Surgery—successful with early detection Death risk Low, but presence of skin lesions At-risk groups Everyone, particularly fair-skinned, blue-eyed people whose skin does not tan or only tans slightly, but burns easily High: More than 940 in Canada in 2009 Source: Canadian Cancer Society; Health Canada Program offered by 1 Introduction to the Program How the Mission UV Program Works? The Mission UV program for Grades 4, 5 and 6 is divided into four themes: 1.0 Mission UV Program • Sun • Skin • Sunscreens • Four types of protection These four themes provide a fairly comprehensive overview of sun protection. However, if you cannot cover all the activities in class with the students, we strongly recommend that you focus on the Four Types of Protection section (Background Reading 1.4). The ultimate aim of the program is to ensure that students remember the four ways of protecting themselves from the sun, which is why this activity is so important. We have also included supporting materials for certain activities at the end of this document for you to photocopy and distribute in class: • Rays • UV rays • Skin types We wish you every success in your mission! 2 Mission UV · Nurse’s Guide Program offered by 3 1.1 Sun—Background Reading 1.2 Skin—Background Reading The sun is the star closest to Earth. It is essential to human life because it provides the energy we need to live. The sun gives us heat and light. Without it, the Earth would be totally dark, cold and lifeless. Plants use the sun’s energy in their photosynthesis process, which helps them produce food and oxygen (two elements that are essential to life on Earth). We humans need the sun because when our skin is exposed to it, we produce vitamin D, which is important for bones and contributes to our well-being. Despite the positive effects of the sun on us, there are unfortunately some negative ones as well. The sun emits ultraviolet (UV) rays that are very dangerous for the skin. UV rays can severely damage the skin’s surface and lower layers. The two types of UV rays that cause skin cancer and from which you need to protect yourself are UVA and UVB rays. Summer is the most dangerous season, especially when the sun’s rays are the strongest. UVA rays are sneaky. They cause damage that accumulates over the years and becomes increasingly visible with time: in the form of wrinkles and brown sun spots, which are hallmarks of skin aged by the sun. UVB rays damage skin more rapidly. They burn unprotected skin. Extensive sun exposure can also bring on a sunstroke, a condition that causes headaches and vomiting in some cases. To prevent UV rays from damaging your skin, you always have to be careful and protect your skin when outdoors. Regardless of the age or colour of skin, it needs to be protected, because it’s very precious. Skin is the largest organ of the human body. It protects you from viruses, bacteria, dehydration and many other harmful things. You have three layers of skin: 1. Epidermis: External and visible part of skin 2. Dermis: Central part 1 3. Hypodermis: Deepest and thickest part of the skin 2 When in the sun, you expose your skin to two types of ultraviolet rays: UVA and UVB rays. UVA rays go deeper into the skin (dermis). They cause premature aging by harming cells and increasing the risk of developing skin cancer. UVB rays affect the skin’s surface (epidermis) and burn it when it’s not well protected. When unprotected skin is exposed to the sun, cells have to defend themselves against UV rays. When the cells cannot defend themselves, skin turns red, is sensitive and often feels itchy. That’s called a sunburn. In severe cases, blisters can form on the skin’s surface. 3 Activities Activities Activity—Sun Objective: Understand the different types of sunrays and their effects Activity—Skin Activity: Discussion and interaction with illustration Objective: Understand skin and its role Supporting material: Use the Rays document at the end of this guide Activity: Discussion and interaction with illustration In-class discussion: Three groups of sunrays reach the Earth: visible light, infrared and ultraviolet rays. The sun also emits other types of rays, but they are stopped by the atmosphere and ozone layer. Show the Rays photo to better illustrate rays and how they penetrate the atmosphere. 1. Visible light is, of course, the light 3. Ultraviolet (UV) rays are the rays that are dangerous for we see with our eyes. These rays are absorbed or reflected off surfaces on Earth, which create different colours. A rainbow shows them separated by colour. our skin. There are two types of UV rays: UVA and UVB. Both types of UV rays can cause cancer. They pass through clouds easily, so even if you don’t feel the sun’s heat, they damage your skin and can give you a sunburn. 2. Infrared rays are heat rays that make us feel the sun’s heat. Clouds block them out easily. 4 Mission UV · Nurse’s Guide • UVA rays don’t burn as much, but they go deeper into the skin and cause premature aging, wrinkles, rashes and spots. > Tip: A is for Age • UVB rays burn your skin > Tip: B is for Burn Supporting material: Use the Skin Types document at the end of this guide In-class discussion: Your skin reacts to the sun to protect you. UV rays stimulate cells in your skin called melanocytes. These cells produce a brown substance called melanin that absorbs UV rays and gives you a suntan. But, be careful! Tanning does not provide sufficient protection. Why doesn’t your skin protect you enough? Why do you need sunscreen and clothing? Over the past 100 years or so, humans have polluted the Earth a lot. Pollution changed the ozone layer so that more UV rays reach us. Skin isn’t designed to handle such intense exposure to rays. Another factor is that we don’t all have the same skin type. Some people have more melanin than others, which explains the differences in skin colours. The darker your skin, the better protected you are from the sun. Show the map (skin types) with the distribution of skin types by global region and explain that skin colours vary according to the amount of sun in each region. These differences are the result of several thousand years of adaptation over many generations. Program offered by 5 1.3 Sunscreens—Background Reading Sunscreens are designed to protect all skin types from sunrays. However, their effectiveness varies. To know how effective a sunscreen is against UV rays, check the following: 1. Sun protection factor (commonly known as “SPF”) that appears as a number on the Classroom Activities Activities—Sunscreens Objective: Understand SPF and how to apply sunscreen properly label, specifying the product’s level of effectiveness against UVB rays. The higher the number, the better the protection. An SPF of 30 or higher is recommended for children. Activity: Discussion 2. Photostability, which maintains the effectiveness of the active ingredient despite Discussion questions: changes in the properties of certain sun filters due to UV rays. 3. The presence of effective UVA filters in the ingredients (such as the Mexoryl® technology for protection against UVA rays). 4. Water resistant, fragrance and colorant free to avoid irritating the skin and 1. What is SPF? SPF is the number on sunscreen bottles. It stands for: Sun Protection Factor. For example, an SPF of 30 provides 30 times more than the skin’s normal protection (when used properly), so an SPF of 15 equals 15 times the skin’s normal protection. The minimum level should be 30, particularly in the summer. attracting mosquitoes. 5. Seal of the Canadian Dermatology Association. 2. How do you use sunscreen properly? People make a number of mistakes when applying sunscreen. The goal is to make children aware of these mistakes to prevent them from recurring. You can ask the students what mistakes they think people make when applying sunscreen and write them on the board. 1 The most common mistakes are: • Applying sunscreen when already in the sun. It should be applied 15 to 30 minutes before going outdoors. This helps the skin absorb the sunscreen. • Never applying enough sunscreen. (You can ask the students how much they think is enough). People generally use a quarter of the amount needed to reach the corresponding SPF level. Apply approximately 30 ml (or the equivalent of 3 tablespoons for the entire body). Children need more as they grow! 2 3 4 • Forgetting to reapply sunscreen, particularly when playing sports, swimming or after drying off. Water, perspiration and rubbing remove sunscreens from the skin leaving it defenceless. Sunscreen also needs to be reapplied every 2-3 hours, because it loses its effectiveness. 5 Practical tips to increase sunscreen effectiveness: • Apply sunscreen on dry skin 15 to 30 minutes before going outdoors. • Apply sunscreen regularly and repeat every 2 hours, as well as after swimming, towel drying or intense physical activity. • Fill the palm of your hand with sunscreen. That amount is generally enough to cover all exposed areas of the body. Use a sufficient quantity for protection equal to the SPF that appears on the sunscreen container. 6 Mission UV · Nurse’s Guide • Forgetting certain areas, particularly the nose, ears, lips and feet. These areas often get burned, because people tend to forget them, even though these are the areas that receive the most sun exposure. • Apply the sunscreen evenly on all exposed areas, including ears, nose, top of feet, as well as the back of neck and knees. • Tanned skin can never replace a good sunscreen. The protection factor of tanned skin is only equal to an SPF of 2 to 4. Furthermore, tanning is the skin’s protection mechanism and a sign that it has been damaged. Program offered by 7 1.4 Four Types of Protection—Background Reading People who get a serious sunburn with blisters when they’re young have a higher risk of developing skin cancer. Young children rarely have skin cancer, but protecting children and teenagers from the sun is crucial for avoiding the risk as an adult. Skin damage from sunburns never disappears. You may forget about it, but your skin won’t. The effects generate cumulative skin damage. That’s why it’s so important to use every method possible to create a barrier between the sun and your skin. There are four ways to protect your skin from UV rays. Classroom Activities Activities—Four types of protection Objective: Identify the four different types of protection and understand the UV index Activity: Discussion and interaction with illustration Supporting material: Use the UV Index document at the end of this guide Protection 1: Wear loose clothing, a wide-brimmed hat Discussion questions: and sunglasses 1. How can you protect yourself from the sun? Clothing provides excellent protection from sunrays. Long, loose and light clothing is better than tightly-woven fabric. Widebrimmed hats and sunglasses with strong UV ray protection really help too. Even when it’s hot outside, you need to cover up to protect your skin. Ask the students to name all the ways they know how to protect themselves from the sun and write them on the board. Sort their answers by category until you can group them into the following four categories: Protection 2: Avoid the mid-day sun • Clothing and sunglasses • Mid-day sun • Sunscreen • Shade The sun is strongest at noon—the time of day when it can cause the most damage. You can protect your skin by not exposing it to midday sun. In Canada, UVB rays are the most powerful in the spring and summer between 11 a.m. and 4 p.m. You can also prompt answers (e.g., when is the sun the most dangerous?). Remember to tell them that as the sun gets stronger, they need more protection. Protection 3: Use a sunscreen with an SPF of 30 or higher 2. How can you find out how strong the sun is and protect yourself the right way? Sunscreens are designed to protect all skin types against sunrays. They contain ingredients that block UV rays and prevent skin damage. There is a very simple tool that everyone can use called a UV index. It’s on TV, in newspapers and wherever there is weather information. The sun’s strength is rated on a scale of 1 to 10, where 1 is the weakest and 10 is the strongest. Depending on the UV index, you can use different ways to protect yourself: Protection 4: Take breaks in the shade Shade blocks the sun and protects your skin. It’s always a good idea to look for shaded areas. UV INDICE INTENSITY PROTECTION REQUIRED AVERAGE EXPOSURE TIME BEFORE SUNBURN WITHOUT PROTECTION The sun and UV rays are present year round, but less so in the winter. That means you need to protect yourself at all times—in spring, summer, fall and winter. Be extra careful in areas where there is water, sand, concrete and snow, because they reflect sunrays. Reflected rays are just as harmful as direct ones. Be sure to protect yourself properly (clothing, sunscreen, etc.) even when it’s cloudy outside. Up to 85% of ultraviolet rays can pass through clouds and damage your skin. Remind children about the importance of protecting themselves from the sun during all four seasons—even when it’s cloudy outside. 8 Mission UV · Nurse’s Guide to Low to Moderate to High to Very high to Extreme 1 hr. 30 min. Program offered by 9 Important Message! The Mission UV program that you just completed is of outmost importance. We would like to thank you once more for helping us to educate youth on sun protection. You could now hand out the letter destined to your student’s parents. 2.0 Sunsmart Tips Mention to your students that they have a first mission to complete as a SPF Super Agent! This first mission is to teach their family about the benefits of sun protection. The second part of this mission is to ask their parents to visit missionuv.com and do the Sun-Smart Parents’ Test. Please note: for every Parents’ Test completed by an adult, your school’s chances to win the SMART Board™ increases! To help us improve our program for Grades 4-5-6 students please fill out the online 2010 questionnaire under the «Nurses» section. You could also contact us by email at info@missionuv.com Thank you! 10 Mission UV · Nurse’s Guide Program offered by 11 2.1 Sunsmart Tips for the Summer Here are a few tips from the dermatologists associated with the Mission UV program that you can share with others. Tips for Everyone Did you know that skin has a “memory”? Any unprotected exposure to harmful UV sunrays in a person’s lifetime creates irreversible effects on the skin and can cause long-term damage. In fact, 80% to 90% of skin cancers are caused by repeated exposure to UV rays. They are present every day throughout the year. That’s why it’s crucial to know how to protect yourself and your family from the damaging effects of UVA rays that age skin and UVB rays that burn skin to fully enjoy your outdoor activities. In addition to applying sufficient sunscreen, Ombrelle recommends the following: • Reduce sun exposure between 11 a.m. and 4 p.m. when the sun is strongest. • Stay in the shade (choose outdoor terraces with parasols or a veranda). • Wear clothing that covers your arms and legs, a wide-brimmed hat and full-coverage sunglasses for UVA and UVB protection. Tips for Active People Most people think about sun protection when they go to the beach or pool, but often forget it when they play sports. Here are a few tips for active people: • Choose light and cool clothing made of cotton or light synthetics. Shirts and jackets with collars help protect your neck. • Don’t forget to wear tinted sunglasses. Select lenses with 100% UV protection and full coverage. • Apply broad-spectrum sunscreen with an SPF of 30 or higher 15 to 30 minutes before going outdoors. • Try to choose the right time of day for your sports activities— preferably before 11 a.m. or after 4 p.m. • When you’re outdoors, exposed to the sun and doing physical activities, be sure to drink lots of water to keep your skin well hydrated and avoid dehydration. Tips for Parents The most harmful effects of sun exposure occur in early childhood. Here are a few tips to protect your child from UV rays: Furthermore, follow these simple rules: 1. Quantity required: Four times more 4. Pay special attention to fragile areas— than you think!—Most people don’t apply enough sunscreen. For an average size adult, a palmful or 30 ml of sunscreen should be sufficient to cover the whole body. This amount can vary for children. Most skin cancers appear on the face, which means that you need to pay special attention to fragile facial areas like the nose, eye contours, ears, hairline and around the mouth. Using a sunscreen that contains moisturizer is recommended for the face. If you prefer sunscreen spray, be sure to spray it on your hands first, then apply it on your face. This avoids getting any liquid in your eyes, which could cause irritation. 2. Apply sunscreen before going outdoors —Sunscreen should be applied 15 to 30 minutes before going outdoors, so the active ingredients have time to penetrate the skin and provide maximum sun protection. It should be reapplied every two hours—particularly after intense exercise or swimming. 3. Apply sunscreen on dry skin— Sunscreen should only be applied on dry skin to ensure absorption and increase its effectiveness against the damaging effects of sun exposure. 12 Mission UV · Nurse’s Guide • Don’t expose babies under the age of one to direct sunlight. Keep them in a covered stroller under a parasol or in the shade. • Apply a generous layer of sunscreen on your child’s skin at least 15 to 30 minutes before going outdoors. Remember to apply lip balm with an SPF of 30 or higher on your child’s lips as well. • Do not apply sunscreen around your child’s eyes, because it can sting and burn. Use sunglasses instead. • Protect your child’s skin with a hat and loose clothing. For more sun protection tips, visit our Web site at: www.ombrelle.ca 5. Use lip balm—Sun exposure can make lips dry and chapped—and increase the adverse effects of the sun. Year-round lip protection is important. Get into the habit of using lip balm with an SPF of 30 or higher. Program offered by 13 2.2 About Ombrelle 2.3 Ombrelle and Education Cutting-Edge Research Launched in 1990 with the close cooperation of Canadian dermatologists, Ombrelle is committed to offering the best sun protection technology in Canada. Ombrelle is recognized by the Canadian Dermatology Association (CDA) and constantly invests in research to maintain its position as a leader. The company was acquired by L’Oréal in 1997. Ombrelle was the first brand to recognize the need for effective protection—not only from UVB rays, which cause most sunburns, but from UVA rays as well, which cause premature skin aging. That’s why it was the first product line with Parsol® 1789 in its formulas, an active ingredient that filters UVA rays. Using research from L’Oréal, Ombrelle continued to refine its formulas and now offers cutting-edge products that incorporate a unique patented filtering system with durable and effective protection against all UV rays. As a result, Ombrelle became the #1 recommended sun protection by Canadian dermatologists and pharmacists. New photostable filter with Mexoryl® XL Broad-spectrum protection Mission UV—National School Program Since children’s skin is particularly vulnerable to the sun’s radiation and that skin damage in childhood is irreversible, Ombrelle set up an education program on sun protection for students in Grades 2 to 6. The program was developed by Ombrelle in cooperation with dermatologists and several influential Canadian professors. The objective of Mission UV is to make children aware of the damage caused by UV rays in a fun and original way. The program, which is based on a special agent theme, gives a mission to each student: learn how to protect yourself and your family from UVA and UVB rays. Mission UV, which was created in 1998, consists of a five-day program that is integrated into the school curriculum and launched every year during National Sun Awareness Week (Grades 2 and 3). The program is presented across Canada in 4,500 classrooms every year National Sun Awareness Week Innovation In the early 1990s, Ombrelle became the first sun protection brand to offer consumers a patented, photostable, broad-spectrum sunscreen. Ombrelle works with dermatologists to identify market needs and develop innovative sun protection products. Using its leading-edge technologies and patented innovations from the L’Oréal Laboratories, Ombrelle offers a whole range of products considered among the best on the Canadian market. Ombrelle is actively involved in educating the public about the importance of sun protection through a variety of community events across Canada. In addition to distributing information through various points of sale, health specialists, elementary schools and its Web site, Ombrelle also works very closely with dermatologists and leading organizations to set up and implement a broad range of awareness programs, including: L’Oréal research has led to a number of important innovations in sun protection, including: Photostable formulas—Recent studies have shown that some filters used to block UVA rays can become less effective when exposed to the sun. The protective properties of these sunscreens progressively diminish. The word “photostable” means that the active ingredients in a sun protection product do not deteriorate when exposed to sunrays. Ombrelle products are consistently avant-garde with photostable protection based on a patented filtering system that maintains their effectiveness when exposed to the sun. Innovative active ingredients—Ombrelle uses the most innovative UV filters including: • Mexoryl® XL sun filter—A patented photostable molecule that works in synergy with Mexoryl® SX and the other filters to be more effective against UVB rays, as well as short and long wave UVA rays. Ombrelle supports the Canadian Dermatology Association (CDA) in the promotion of healthy sun habits during National Sun Awareness Week. Ombrelle forms partnerships with the media for the Week and ensures coverage by major Canadian media to promote the CDA’s sun protection awareness campaigns. During the Week, Ombrelle also offers a variety of educational activities, including the annual launch of the Ombrelle UV Patrol and Mission UV programs. Youth Section—missionuv.com To help educate children and their parents in the comfort of their own home, Ombrelle and Mission UV offer educational information on sun protection on the missionuv.com website. In addition to tips and suggestions on sun protection, the Youth Section on the website includes interactive games along with quizzes to build awareness about the importance o • Mexoryl® SX sun filter—A patented photostable molecule that absorbs short wave UVA rays that go more deeply into the skin than UVB rays. • Parsol® 1789 (Avobenzone)—A patented photostable molecule that absorbs long wave UVA rays that go more deeply into the skin. 14 Mission UV · Nurse’s Guide Program offered by 15 RAYS 2.4 Ombrelle Product Lines For your personal information, the Ombrelle product lines and their features are described below: Regular Protection INFRARED • UV protection with Mexoryl® technology and other sunscreen filters • Patented photostable UVA-UVB protection • Water-resistant • Hypoallergenic and non-comedogenic • Fragrance and colorant free • Available in SPF 15, 30, 30 Extreme, 30 Lip Balm, 45 and 60. Face Protection UVB • UV protection with Mexoryl® technology and other sunscreen filters • Patented photostable UVA-UVB protection • Water-resistant • Gentle formulas • Hypoallergenic and non-comedogenic • Fragrance and colorant free • Available in SPF 30, 30 Sensitive Skin, 45 and 60. UVA Kids’ Protection VISIBLE LIGHT • UV protection with Mexoryl® technology and other sunscreen filters • Patented photostable UVA-UVB protection • Water-resistant • Ultra-light texture • Hypoallergenic and non-comedogenic • Fragrance and colorant free • Available in SPF 30, 45 and 60, 60 Face Stick. 16 Mission UV · Nurse’s Guide SMOKE DUST CLOUDS • UV protection with Mexoryl® technology and other sunscreen filters • Patented photostable UVA-UVB protection • Sweat-proof, waterproof and non-greasy formula • Hypoallergenic • Fragrance and colorant free • Convenient application • Special texture recommended for hairy body areas • Available with SPF 15, 30 and 45. OZONE Sport Protection Program offered by 17 18 Mission UV · Nurse’s Guide Program offered by 19 High Very high Extreme to to to Tropic of Capricorn Equator Lighter Skin colour Darker Moderate to Tropic of Cancer Low INTENSITY to UV INDICE [Source: Pascal Léonardi, Muséum National d’Histoire Naturelle] (Populations considered native for millennia) SKIN TYPES UV RAYS 1 hr. 30 min. WITHOUT PROTECTION SUNBURN AVERAGE EXPOSURE TIME BEFORE GLOBAL DISTRIBUTION OF SKIN COLOURS PROTECTION REQUIRED 317, PLACE D’YOUVILLE - 2e ÉTAGE MONTRÉAL (QUÉBEC) H2Y 2B5 info@youvillecc.com 514-789-8800 DATE VERSION FORMAT COULEURS APPLICATION Quarkxpress passeport 7 CMYK 04-05-2010 V3 8.5 X 11 po Ycc-1042_4e5e6eAn_Guide Infirmière10_EN_v3 DOSSIER 1042 OMBRELLE DESIGNER GRAPHIQUE DIRECTEUR ARTISTIQUE NADIA BOILARD Pooja Subramanian CLIENT RELECTEUR / RELECTRICE DIRECTEUR DE PRODUCTION RON SZEKELY CHARGÉ (E) DE COMPTE INFOGRAPHISTE VIVIANE QUESNEL DIRECTEUR DE COMPTE Program offered by