Histoire et fonctions des Unités pour Malades Difficiles (1re partie). Du quartier de sûreté à l’Unité pour Malades Difficiles de Villejuif,plus d’un siècle de prise en charge

This article is the first in a series of three, dedicated to the history and functions of what is known as a UMD in France: Unités pour Malades Difficiles, or “Units for Difficult Patients”. This particular article focuses on the oldest such secure structure, UMD Henri Colin, created in 1910 in Villejuif as a quartier de sûreté, or a “secure ward”. The article aims to detail evolutions in treatment and the types of patient treated over more than one hundred years, parallel to social change. Four distinct chronological periods are examined, for their perspective on professional practice as much as for the reasons given for patients’ admission and the psychopathological profiles of “dangerous” patients. Clinical vignettes are used to illustrate this historical evolution.     

Quelles interventions pour améliorer le bien-être des étudiants en médecine ? Une revue de la littérature

Physician's psychological distress has been known for more than a century. A meta-analysis found an increase in the suicide rate among physicians, compared to the general population, with a relative risk of 1.41 for men and 2.27 for women. Among interns, the prevalence of depression or depressive symptoms is estimated at 28.8% (IC 95% = 25.3%–32.5%). The suffering of medical students prior to internship has been recognized more recently. But now there are many studies, and a few meta-analyses, which have evaluated the prevalence of anxiety, depression, burnout and, more generally, the lack of well-being. Among medical students, the prevalence of depression or depressive symptoms is estimated at 27.2% (IC 95% = 24.7–29.9) and that of suicidal ideation of 11.2% (CI at 95% = 9.0–13.7). Another meta-analysis found a prevalence of burnout of 44.2 % (IC 95% = 33.4–55.0). Since the problem has been known researchers have tested interventions to improve the well-being of students. Our work aims to review interventions to help medical students and use validated scales. A review was published in 2016 about interventions on the learning environment, and the well-being of medical students was published; 28 studies were identified. But they did not systematically use validated questionnaires allowing a quantitative approach. Interventions included: pass/fail scoring systems (n = 3), mental health programs (n = 4), psycho-corporal skills programs (n = 7), curriculum structure (n = 3), multi-component program reform (n = 5), wellness programs (n = 4), and counseling/mentoring programs (n = 3). We chose to focus only on studies using validated questionnaires. A search was performed in the MEDLINE biomedical electronic database until July 31, 2018. The inclusion criteria were: original study, in French or English, concerning medical students prior to internship involving an intervention to improve the well-being of medical students by measuring at least one criterion of psychological distress (anxiety, burnout, depression…) using a validated scale. Thirty-six studies were included in this review. The quality of the studies is very heterogeneous. We can distinguish three types of intervention: institutional (modification of the system of notation, classification…), in-group (management of the stress, therapy full of conscience, relaxation, psychoeducation…) or individual (screening and support custom). These interventions encompass all levels of prevention (primary, secondary and tertiary). There is limited effectiveness of group interventions. This effectiveness disappeared after SIX months with the exception of institutional interventions. The data set encourages us not to favor a single type of intervention but to promote a global intervention acting at all levels. In particular, researchers can draw on studies of doctors and interns. France is late to come to the issue with few published studies on interventions to improve the well-being of students, but recent awareness seems to have taken place. Our study has some limitations: restriction to French and English, the choice to select only comparative studies using validated scales which limited the number of studies selected but also the type of interventions not all of which allow a quantitative evaluation. In the interventions not taken into account in this review, several seem promising. They mainly involve secondary prevention: improving the training of staff and students in the detection of symptoms of depression, burnout and psychological stress, screening at-risk populations, and communication campaigns to combat the stigma of psychiatric disorders and encourage students to consult. But tertiary prevention is also of interest: have psychologists and psychiatrists in the faculties accessible to students who feel the need and can also accommodate. Finally, a certain number of faculties have set up vocational guidance and selection aids that are appreciated by students but have not been evaluated for their impact on students’ health. Recent studies and meta-analyses indicate a significant prevalence of outstanding medical students, however, there is reason to be optimistic. Many health professionals and researchers are interested in the problem as well as the means to remedy it. Most studies are effective in the short term. However, the methodological limitations (low number of subjects, limited follow-up time…) and the heterogeneity of studies concerning interventions (mindfulness, psychoeducation…) on students do not allow us to conclude that they are effective in the long term. It should therefore rather move towards comprehensive care acting on the three levels of prevention: primary (institutional interventions/speech groups/psycho education), secondary (screening of subjects at risk, speech groups/psycho education/others) and tertiary (individual interventions).     

Adolescent social withdrawal,parental psychological control,and parental knowledge across seven years: A developmental cascade model

IntroductionSocial withdrawal can be problematic for adolescents, increasing the risk of poor self-efficacy, self-esteem, and academic achievement, and increased levels of depression and anxiety. This prospective study follows students across adolescence, investigating links between social withdrawal and two types of parenting hypothesized to impact or be reactive to changes in social withdrawal.MethodsAdolescent social withdrawal and parenting were assessed across seven years in a U.S. sample, beginning when students were in 6th grade and ending in 12th grade. The sample consisted of 534 adolescents (260 girls and 274 boys, 82% Euro- and 16% African-American). Social withdrawal was assessed in four grades using at least two informants (teachers, mothers, and/or adolescents). Mothers' and fathers' psychological control and monitoring-related knowledge were assessed by adolescents at two time points. A developmental cascade analysis was conducted using structural equation modeling to assess how withdrawal and control-related parenting impact each other transactionally over time. Analyses included a test for gender differences in the model.ResultsThe cascade model revealed that, controlling for previous levels of social withdrawal and parenting, earlier social withdrawal positively predicted psychological control and negatively predicted monitoring knowledge, and earlier parental psychological control—but not monitoring knowledge—predicted later social withdrawal. No adolescent gender differences were identified in the associations between social withdrawal and parental knowledge.ConclusionsThis study offers insight into the mechanisms by which adolescents become more or less withdrawn over time, and suggests psychological control as a point of psychoeducation or intervention for parents.     

Quality of life after fracture-related infection of the foot

BackgroundFracture related infection (FRI) of the foot is a serious hazard. Despite successful therapy, the physiological and psychological involvement seems to be high. Therefore, we aim to analyze the impact of an FRI of the foot on the quality of life after successful surgical therapy and infect eradication.MethodsIn total, 25 patients from two German hospitals treated for FRI of the foot between March 2011 to January 2020 were retrospectively included. Quality of life was assessed by the German Short Form 36 (SF-36) and the EuroQol five-dimension three-level questionnaire (EQ-5D) as well as the ICD-10 based psychological symptom rating (ISR), and compared to a norm obtained from the general population of Germany.Results3.0 years (range 0.7–7.9 years) following final surgery after fracture-related infection of the foot, the mean physical health component score (PCS) of the SF-36 was 35.6 ± 12.3, and the mean mental health component score (MCS) of the SF-36 reached a value of 41.3 ± 12.9. Both values were significantly lower than in the general population of Germany (p< .019). The mean scores of the ISR of the cohort crossed the threshold of mild symptom burden in total, as well as for the subscales depression and somatization. The mean EQ-5D VAS rating (62.1 ± 18.6) and the EQ-5D index value (0.66 ± 0.27) were significantly lower in comparison to a score of 72.9 ± 1.0 and 0.88 obtained from an age-matched reference population (p < .01).ConclusionFRI of the foot represents a major burden for the patient. Physical and mental well-being of affected patients is restricted albeit successful treatment in terms of infect eradication and bone union has been achieved after a mean follow-up of 3.0 years. A patient-centered treatment approach focusing on improvement of quality of life during and after treatment is therefore warranted.     

Over 55 years of critical power: Fact or artifact?

This report aims to generate an evidence-based debate of the Critical Power (CP), or its analogous Critical Speed (CS), concept. Race times of top Spanish runners were utilized to calculate CS based on three (1500-m to 5000-m; CS_1.5-5km) and four (1500-m to 10000-m; CS_1.5-10km) distance performances. Male running world records from 1000 to 5000-m (CS_1-5km), 1000 to 10,000-m (CS_1-10km), 1000-m to half marathon (CS_{1km-half marathon}), and 1000-m to marathon (CS_1km-marathon) distance races were also utilized for CS calculations. CS_1.5-5km (19.62 km h^?1) and CS_1.5-10km (18.68 km h^?1) were different (p < 0.01), but both approached the average race speed of the longest distance chosen in the model, and were remarkably homogeneous among subjects (97% ±1% and 98% ±1%, respectively). Similar results were obtained using the world records. CS values progressively declined, until reaching a CS_1km-marathon value of 20.77 km h^?1 (10% lower than CS_1-5km). Each CS value approached the average speed of the longest distance chosen in the model (96.4%–99.8%). A power function better fitted the speed-time relationship compared with the standardized hyperbolic function. However, the horizontal asymptote of a power function is zero. This better approaches the classical definition of CP: the power output that can be maintained almost indefinitely without exhaustion. Beyond any sophisticated mathematical calculation, CS corresponds to 95%–99% of the average speed of the longest distance chosen as an exercise trial. CP could be considered a mathematical artifact rather than an important endurance performance marker. In such a case, the consideration of CP as a physiological “gold-standard” should be reevaluated.     

全面护理模式对心血管介入术后患者心理状态及睡眠质量的影响

目的研究全面护理模式对心血管介入术后患者心理状态及睡眠质量的影响。方法选取于我院行心血管介入手术的102例患者作为研究对象,采取随机数字法将其分为观察组(51例,常规护理+全面护理模式)和对照组(51例,常规护理模式)。比较两组的睡眠质量、心理状态、生存质量及并发症发生情况。结果护理1个月后,观察组的PSQI评分明显低于护理前及对照组(P<0.05)。护理2周后,观察组的SCL-90各心理状况因子评分均明显低于护理前及对照组(P<0.05)。护理2个月后,观察组WHO-QOL中的生理功能、心理状态、环境、社会关系、独立性及总体评分均明显高于对照组(P<0.05)。观察组患者术后各项并发症发生率均显著低于对照组(P<0.05)。结论全面护理模式有助于改善心血管介入术后患者的心理状况和睡眠质量,降低并发症发生率,提高患者生存质量。     

优化全程护理在准分子激光上皮瓣下磨镶术中的应用效果

目的探讨优化全程护理在准分子激光上皮瓣下磨镶术中的应用效果。方法选取2017年7月至2019年7月本院收治的200例准分子激光上皮瓣下磨镶术患者作为研究对象,按照随机数字表法将其分为研究组与对照组,各100例。研究组实施优化全程护理,对照组实施常规护理。比较两组的护理效果。结果护理后,两组的SAS、SDS评分均低于护理前,且研究组低于对照组(P<0.05)。研究组的并发症总发生率低于对照组(P<0.05)。术后1、3个月,两组的视力水平均高于护理前,且研究组高于对照组(P<0.05)。研究组的护理满意度明显高于对照组(P<0.05)。结论优化全程护理应用于准分子激光上皮瓣下磨镶术中可调节患者心理状态,减少术后并发症的发生,促进视力恢复,提升护理满意度,值得临床推广应用。     

Inflexibilidad psicológica e impacto clínico: adaptación del Cuestionario de Aceptación y Acción-II en una muestra de pacientes en tratamiento de hemodiálisis

Background and objectivesFew studies have investigated the role psychological inflexibility (PI) could have in the context of chronic renal failure. The primary objective of this study was to analyse the psychometric features, the reliability and the validity of the Spanish version of the Acceptance and Action Questionnaire-II (AAQ-II) adapted to the context of patients undergoing haemodialysis (HD). The secondary objective was to assess the relationship between PI and parameters related to the adherence to treatment and quality of life in these types of patients.Materials and methodsProspective cross-sectional study with patients on haemodialysis (n = 186).ResultsThe fat tissue index (15.56 ± 5.72 vs. 18.99 ± 8.91, P = .033), phosphorus levels (3.92 ± 1.24 vs. 4.66 ± 1.38; P = .001) and interdialytic weight gain (1.56 ± 0.69 vs. 1.89 ± 0.93, P = .016) were higher in patients with a higher PI score. Phosphorus levels (P = .013) significantly explained the variability of PI levels. PI was also shown as a significant predictor (P = .026) of the variability of phosphorus levels.ConclusionsThe adaptation of the AAQ-II questionnaire to the HD context led to a valid and reliable measurement of PI in these types of patients and our results also seem to support the relationship between PI and health and quality of life parameters in patients with chronic conditions.     

Relación entre estrés y malestar psicológico de los padres y problemas emocionales y conductuales en niños preescolares con trastorno del espectro autista

IntroductionThe Autistic Spectrum Disorders (ASD) are characterised by general deficits in social communication, stereotypes, and restricted interests. The ASD have a high prevalence of additional psychiatric disorders that make their daily functioning worse, and reduces the quality of life of them and their families.Material and methodsIn an effort to identify family environmental characteristics that may influence in the course of additional psychiatric disorders, this study has focused on the symptoms of parental stress and psychological distress as possible risk factors. A cross-section study was carried out on the relationship between the stress and psychological distress of the parents and its relationship with co-existing psychopathology in a population of pre-school children with ASD (2-6 years).Results and conclusionsHigh levels of stress and psychological distress of the parents arealready associated, since early childhood, with co-existing psychiatric symptoms, specifically with emotional and behavioural problems (p < 0.05). However, further longitudinal studies are needed for a better understanding of the causal relationship between these variables and their possible bidirectional relationship.