Évaluation des connaissances et des pratiques d’hygiène des mains au niveau de l’unité de néonatologie et soins intensifs du service de médecine infantile et néonatologie de l’hôpital Nord, Marseille

Background

The hygiene of hands stays the basic measure to reduce the incidence of the hospital-borne infections. Its importance is major in a service of neonatology. Our work aimed at estimating the knowledge and the practices on the hygiene of hands.

Method

The study was realized at the level of the unit of neonatology and the intensive care of the service of infant medicine and neonatology of the north hospital of Marseille and took place from 1st till 15 August 2008.

Results

We questioned 55 persons of the staff, seek attendants and observed 30 persons. Near the quarter of the staff (23.6%) think that the solutions hydro-alcoholic are less effective than the simple wash of hands and more half (the 51%) than they are less effective than the hygienic wash. In respectively 20% and 36% of the cases, the staff underestimates the duration of the procedure of wash of hands and the hydro-alcoholic friction. In 58.1% of the cases, the staff ignores that the hydro-alcoholic solutions can be used in all the situations where hands are not soiled. Attendants seems to have a good knowledge of the hydro-alcoholic solutions. They know the indication about it in 56.2% of the cases and think that they are effective in 50% of the cases. The staff seems to have a good theoretical knowledge (87.2 in 96.4%) measures of hygiene of hands to be before adopted and after the most current gestures in the unit. There is an inobservance of the hygiene of hands in 33.3% of the cases. None of the persons outside the service practised a measure of hygiene of hands. A bad quality of the wash of hands concerning the contagion at the end of procedure was found in 64.7% of the cases and it in all the observed categories.

Conclusion

There is a real lack of information of the staff about the hygiene of hands. For the improvement of the quality of the care, the evaluation of the practices and the training of the staff turn out indispensable.     

Évaluation des troubles autistiques avant trois ans : l’expérience de l’« UNIDEP » (Unité de dépistage et d’évaluation précoce des troubles envahissants du développement)

In this article we will present our early detection local program of autism and invasive developmental disorders. It is to detect and evaluate children under the age of three, in order to propose proper treatment as quickly as possible. First of all we will present the different aspects of the program working within a network. On one side the collaboration with different structures such as the maternal and infant protection (PMI) and on the other the collaboration with institutions that will specifically take care of these children. The proper evaluation will be then explained and our methods will be further detailed. Secondly, we will share our clinical studies stemmed from our experience and will then consider diagnosis announcement, alliance and therapeutic process. This will then be followed by case studies that will highlight the therapeutic dimension, which already seems to exist in this evaluation phase.     

Élaboration et validation de l’inventaire des facteurs de résilience (IFR-40)

The following article reports the development procedures and the psychometric validation of the inventory of the resilience factors (IRF-40). This questionnaire has been worked out in order to evaluate the protective factors working together towards resilience. An exploratory factor analysis was conducted on 299 French participants in order to investigate the factor structure of the IRF-40. The convergent validity, the temporal stability (test-retest reliability) as well as the internal consistency have been examined. The analyses have confirmed the three-factor structure of the IRF-40 (personal protective factor, family protective factor and extrafamilial protective factor). In addition, the results have revealed that the internal consistency and validity of the questionnaire were good. Finally, the results have indicated that the IRF-40 is very stable over time, thus supporting its temporal stability. This French questionnaire proves to be an appropriate and useful tool for clinicians and researchers for the study of adolescents’ resilience.     

De l’acquisition à l’attribution du nom de famille,réflexions sur la transmission

Recent legal provisions, in force since January 2005, allow parents to declare a family name for their first child by choosing it among their own names. The term “Family name” has since replaced that of “patronymic” and a new registered form has been created, “the double name” associating both the father's and the mother's family name. This reform, being as important as complex and which began in 2002 and was implemented in 2005, particularly affects the method of transmission of the child's name and offers research new openings which will enable us to explore the representations of family in society today. This new institution, in that it favors the transmission of the name following the process of attribution, carries with it, until childbirth, an extra burden of personal commitment. It also highlights the permeability of the unconscious psychic issues and points out the singularity of the notion of transmission, which takes its color through a movement of appropriation singular to each individual within his or her history.     

La loi de 2005 organisatrice des réponses entre la MDPH,l’école et le soin

Relationship between psychiatric care for children and adolescents and its management of disability have been for a long time a matter of debate. The law of February 11th 2005 “for equal opportunities and rights, participation and citizenship of handicapped people” introduced several points that guide missions of MDPH (the Office for persons with disabilities): it gives an innovative definition of the concept of handicap and introduces the notion of a psychic handicap. According to the principle of equal opportunities, the right to schooling for everybody (under the supervision of National Education) and the right for compensation of the handicap (under the supervision of the newly created “Commission of Rights and Autonomy”) call for social and individualized therapeutic management in a global approach. Decentralization reform increases heterogeneity of implementations of the law, triggers new interaction processes between health and social care organizations and lets emerge new practices. The consequences of this, in the therapeutic management of psychiatric care for children and adolescents, are not yet delineated.     

Handicap et troubles mentaux de l’enfant chez les ruraux au Sénégal

Background

Like the other African developing countries, in Senegal, disparities in health services between towns and the rest of the country are very important in, particularly, the main town. Only some populations have opportunities to get enough quality of care health services. A lot of children and adolescents endure chronic diseases or handicap without correct assistance. Only one modern unit gives the children and their family adequate mental health cares.

Objectives

The authors try to determine the sociodemographic characteristics of the children coming from rural areas and consulting in child-psychiatry unit of Fann Hospital (Ker Xaleyi). They examine the origins of their mental handicap and make also the analysis of the main elements. At the end, some tracks of solutions are proposed.

Methods

Retrospectives data are used by consulting files of the children who have consulted at the years from 2000 to 2006 in the child-psychiatry unit “Kër Xaleyi”. Starting from the whole, those concerning the areas outside the main town (Dakar) are particularly analyzed. Data are treated by the freeware Epi Info 6 which is a series of programs for use by public health professionals, general database and statistics applications. In this work, the frequencies are mostly calculated concerning gender, age, repartition by region, kinds of disorders and diseases related to handicap.

Results

Only one quarter of the patients comes from rural areas. Some regions are poorly represented like Tambacounda and Kolda. Repartition about gender is not so different whatever the region or the trouble considered. Intellectual deficiency is more frequent as handicap. Concerning the sources of the mental handicap presented by many children, a majority is related to organic affections.

Analyze/Discussion

The differences seem to be linked to geographic availability (more the region is far from main town, less the population is represented in the unit), traditional convictions (persons are more in contact with mystic and irrational considerations in rural areas unlike the metropolitan citizen who have more information and education) and the poverty level is a characteristic of our rural areas (health care services and the means of transport are more developed in the city). Malaria and purulent meningitis cause sequels, which are aggravated by deficiency of taking care and inefficiency of prevention.

Conclusion

Despite real difficulties in rural areas, a reduction of the gap in health services between the main town and the other cities can be realized by a better prevention policy, a better exchange of ideas between actors and new consideration of sociocultural realities.     

Diagnostic des réactions d’hypersensibilité allergique et non allergique aux médicaments courants de l’enfant : arbre décisionnel

Suspected allergic reactions to drugs and biological substances (anti-infectious drugs and antipyretics, non opioid analgesics and nonsteroidal anti-inflammatory drugs especially) are reported in 5 to 12% of children. Most frequent reactions are morbilliform/maculopapular rashes, urticaria and angioedema. Other cutaneous and respiratory reactions, and severe allergic and non-allergic anaphylactic reactions are rare. The results of studies based on allergological tests and/or microbiological/serological tests strongly suggest that, except for a few types of reactions (anaphylactic and/or immediate reactions, potentially harmful toxidermias) and for very specific drugs (i.e. latex and myorelaxants), most reactions to commonly used drugs and biological substances in children do not result from drug hypersensitivity, but are rather a consequence of the infectious and/or inflammatory diseases for which the drugs have been prescribed. Non-immediate reactions may also result from complex interactions between drugs, immune system and “danger signals” provided or induced by infectious and/or inflammatory diseases. Diagnosis is based above all on a detailed analysis of clinical history, skin tests (if validated), and challenge tests (if indicated). At present, the diagnostic and predictive values of in vitro tests exploring immediate (specific IgE determination, histamine and leukotriene release tests, basophil activation test) and non-immediate type (lymphocyte activation tests, and cytokine assays in the supernatant of activated blood mononuclear cells) of drug hypersensitivity are not validated.     

Troubles du langage oral et écrit chez des jeunes pris en charge par l’aide sociale à l’enfance et bénéficiant de soins hospitaliers

Background

Children and adolescents involved with foster care are a population at high risk of developing psychiatric disorders and poor language skills. Here, we aimed to assess in children and adolescents admitted in a university department of child and adolescent psychiatry whether being involved with foster care would change oral and written language impairments they face.

Method

We conducted a case-control study in a sample of 104 inpatients aged six to 18 years (50 supported by foster care; 54 not supported). Assessment included family and medical histories, axis 1 diagnoses and a systematic screening of written abilities using the French version of the 1-minute reading test, a spelling task and two tasks of sentence comprehension. For subjects showing at least one score below two standard deviations at one screening task, a full language assessment was performed including tasks for oral language, phonological skills, word identification, naming speed, syntax and comprehension.

Results

We found more language impairments in inpatients involved with foster care than controls. They had lower scores in complex language comprehension tasks, more impaired phonological skills, and more fragile word identification strategies (both the grapho-phonologic conversion and the assembling strategy). We found a significant association between language and gender (male), intellectual disability and pervasive developmental disorder. Although externalized disorders were significantly associated with written language impairment, this association was mediated by gender. Finally, children and adolescents involved with foster care were at higher risk not to be treated for a language impairment (odd ratio = 3.5 [95%CI : 1.03–12.05], P = 0.038).

Conclusion

The severity and prevalence of language impairments among youths involved with foster care and requiring psychiatric inpatient stay show the impact of learning disabilities in this population. In terms of prevention, assessment of language skills should be promoted in this population as they appear to be at risk of not receiving proper speech or reading remediation.