ObjectiveThe objective of the present study was to investigate the risk factors for intussusception (IS) among infants, including vaccination against rotavirus.MethodsCase-control study with systematic inclusion of all infants aged <1 year with suspected IS admitted to emergency departments in the eastern region of France between 1 April 2008 and 31 March 2012. All cases classed level 1 according to the Brighton classification were matched to 4 hospital controls. Two exposure windows were examined; exposure to the first dose of rotavirus vaccine in the 7 and in the 14 days prior to the occurrence of IS.ResultsA total of 115 cases were matched with 457 controls. The average vaccination coverage rate over the 4 years of study was 8.6%. Rotavirus vaccine was not found to be significantly associated with the occurrence of IS in the 7 days (odds ratio (OR) not calculated; p = 0.99) and in the 14 days after administration of one dose vaccine (OR 1.33, 95% confidence interval (CI) 0.14–12.82). Infant formula alone or combined with breastfeeding was associated with an excess risk of IS (OR 2.74, 95% CI 1.10–6.79). A history of gastroenteritis within 2 weeks prior to hospitalisation was also associated with an increased risk (OR 2.24, 95% CI 1.07–4.67).ConclusionOur study indicates that infant formula alone or combined with breastfeeding is a risk factor for IS. A small, non-significant increase in the risk of IS was observed after rotavirus vaccination, although the low vaccine coverage rate likely precluded detection of a significant increase in risk. 相似文献
Background/Aims: Neuropsychiatric symptoms (NPS) in dementia pose great challenges for residents and staff in nursing homes. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a randomized controlled trial demonstrated reductions in NPS. We explored the participating staff's experiences with the model and how it meets the challenges when dealing with the complexity of NPS.
Methods: Three to six months after the end of the intervention, we interviewed 32 of the caregivers, leaders, and physicians participating in the trial, in five focus groups. We used thematic content analysis.
Results: The analysis yielded two main themes: (1) a systematic reflection method enhanced learning at work; (2) the structure of the approach helped staff to cope with NPS in residents with dementia.
Conclusion: TIME shifts the way of learning for the staff from a traditional to a more innovative and reflection-based learning through a process of learning how to learn at work. The staff's experienced increased coping in their approach to complex problems. Our results emphasise the importance of a structured and biopsychosocial approach to NPS in clinical practice. Future research should explore models for integrating situated learning in daily routines in nursing homes. 相似文献
ObjectivesThe adolescence corresponds to this existential period when the violence in its creative and destructive functions is the mainspring at the same time and challenge. During this time of passage, the young has to negotiate with himself, his family and the others. Stage of transformation and transfer, revival of multiple psychic conflicts, the adolescence sees the sexuality penetrating the reality of the body. In this context in which the rising sexual activity is associated with a concern, the misunderstanding occupies a central place in the sense where most of the time the protagonists involved in acting him hardly took the opportunity to speak to itself and to get on. Behind a misunderstanding, there are on one side facts and the other one a subject which put them in act.Patients and methodsThe article develops a clinical label involving three adolescents, a boy and two girls. Misunderstandings quickly appear about activity of sexual nature. The excitement gets involved in the fears not without generating of the ambivalence. The mutual incomprehension contains a potential trauma. It is then relevant to intervene without wanting inevitably to define the truth in its material translation of the reality. A type of dense and flexible care gives encouraging results as for the reduction of the traumatisation of a particular event. We move forward stage by stage by proposing times of meeting with a rhythm enough steady and by lending us if necessary as media of expression. Yet it is hardly always well-to-do to act not in the haste but with density and speed in the interest of some of the others. It is essential to take into account at the same time relational stakes, their impacts on the individualities, and the psychic dimensions appropriate to every protagonist. A collective and personal historian can develop in these testing moments of crisis on basis of an intervention such as sketched here, by considering repercussions at the level of the socio circle of acquaintances.ResultsThe approaches which establish themselves on the only reality of the behaviour risk to evacuate the subject which puts the qualified act of worrying. For us we suggest dreading the subjective dimension by examining the question of the sexuality from the point of view of the functioning of a personality. In other words, the question is not only of knowledge which is the act which was put, but to know which committed it. We thus watch to construe the subjective impact of the act, by reminding that the human being becomes established as subject of his speech and as agent of his act. The misunderstanding also constitutes an original media of meeting of the teenager in question. We propose a categorization of worrisome sexual activities by underlining that, in number of scenarios, the young person shows elements of several categories: a/the young people in sexual life without restraint; b/the young people confronted with the constraint of the anxiety; c/the young people led by an intense need for love; d/the young people committing sexual abuses; e/the young people showing a perversion. Besides, we shall not evoke rare disturbing sexual activities put aside by the young people in the psychotic functioning. The care leans on two concepts-keys, on one hand, the succession of two different phases, that are the evaluation and the treatment and on the other hand, the complementarity of several epistemology as well as the work in network. We advocate the establishment of a partnership envelope based on the collaboration and the respect of the principles of the shared secret.ConclusionsThe misunderstanding can reveal a worrisome sexual activity in the adolescence. Indeed let us limit the current trends “to tax” any sexual act of aggression, and his author of “abuser”, and the addressee to act him of “victim”! To limit, we determine what belongs to the physical, sexual exploration, including the consensus of the protagonists, what goes out again from the pathology. The distinction is essential at the risk otherwise to stigmatize certain young people in full constructive run-up by gathering in a single troop of the different profiles from each other. The misunderstanding represents a beautiful opportunity of meeting of a young person in the inviting to a correct interpretation of the facts, by taking into account the place they occupy in the psychic and relational functioning. 相似文献
Women with cervical intraepithelial neoplasia grade 3 (CIN3) have a long-lasting increased risk for noncervical high-risk human papillomavirus (hrHPV)-related (pre)malignancies. The aim of our study was to estimate this risk in women with recurrent CIN3 compared to women without a history of CIN3 and women with a single episode of CIN3. Women with a CIN3 diagnosis between 1990 and 2010 were obtained from the Dutch Pathology Registry (PALGA) and matched with a control group of women without CIN3. Analysis has been conducted in a subset of women with recurrent CIN3, defined as reoccurrence minimally 2 years post-treatment. Cases of noncervical hrHPV-related (pre)malignancies of the anus, vulva, vagina and oropharynx were identified until 2015 and incidence rate ratios (IRRs) were estimated. Then, 1,797 women with recurrent CIN3 were included with a median age of 34 years (range 18–76) and 31,594 person-years of follow-up. Women with recurrent CIN3 had an increased risk of developing noncervical hrHPV-related (pre)malignancies compared to women without CIN3 with an IRR of 25.96 (95%CI 6.32–106.58). The IRR was 2.48 (95% CI 1.87–3.30) compared to women with a single episode of CIN3. Studies on posttreatment follow-up and prophylactic hrHPV vaccination are warranted. 相似文献