Témoignage à l’attention des enseignants des universités et des centres de formations

The writers propose that an academic learning and continuing educations may be conceived from the experiences of its teams and those of clinicians who get involved in the different socio-educational and judicial sectors. They suggest that novice professionals emerging from the clinical and educational scenes – who have to deal for the first time with practices with teenagers – may be taken into account. They have to receive knowledge about the teenager and his environment and they also need landmarks in order to be able to exercise other jobs confronted with the same situation. According to them the acid test of the interdisciplinary works is anthropology: discipline focused on the understanding of the humans. The presence in the socio-educational and judicial fields of teenagers the most affected by difficulties is considered as a clinical paradigm (frequency of co-morbidity behind a social trouble). To conclude this paradigm introduces the concept of “sacrificed children”.     

Traitement des plaies « simples » : choix des différentes sutures

The suture, when possible, is the best method to close a simple wound. It must be preceded by debridement and performed with great care. A rigorous technique applied in the best possible environment is necessary but not always sufficient to achieve a good cosmetic result.     

Les vertes années des Maisons des adolescents

Thirty years ago, Françoise Dolto created in Paris a place of reception of the children from 0 to 3 years old accompanied by an adult. Place of transition, before the entrance to day-nursery or to the nursery school, the “Maison Verte” has for main purpose to organize a premature disease prevention by limiting the effects of a separation not prepared between relatives and children. Before the passage in the adulthood, the question of the separation can again become updated in the “Maison des adolescents” as the frequent consultations for teenagers in the motive for a separation show him it which lives outstanding. One of the objects of this article will be to discuss the question of the separation and the development of the relations relatives – children around this one and to try to show how a space of care, at once containing by its name, a house, easily recognizable and of simple access can be the place where the fears are going to be able to elaborate.     

Apports des explorations vasculaires ultrasonores à l''étude des néphropathies chez l''enfant

The proximity of child's kidneys from the cutaneous surface allows a particularly sensitive exploration by doppler sonography, which in addition has the major advantage of being a non-invasive, non-irradiating and painless technique. However there are two limitations to this technique: the lack of cooperation of some children and the still limited availability of high quality equipment in intensive care units. Indeed most of the applications described in this paper (ie. pyelonephritis, renovascular hypertension, tumors, acute renal insufficiency and renal vein thrombosis) require, besides an experienced operator, expensive power doppler equipment including high frequency and high resolution probes.     

Nouvelles données sur I'étude des anomalies constitutionnelles des enfants et des particularitéy de leur metabolisme.

Professeur de clinique des maladies infantiles de l'Academie Militaire de Médeeine à Leningrade.     

Pertinence du Fairy Tales Test chez des enfants français ayant des troubles des apprentissages : résultats préliminaires

Background

The authors have started a preliminary research to start the French validation of a new projective tool for children created by Coulacoglou (1996): The Fairy Tales test (FTT). Using tales to invite the child to tell a story is not rare in the field of child clinical psychology (Düss, 1949; Royer, 1978; de Tychey, 1993). FTT is a novel way of accessing the inner life of children through structured fantasy and storytelling. The FTT has the advantage of using stories that many children are familiar with (Little Red Riding Hood, Snow White and the Seven Dwarfs). The FTT includes an interview guide (many questions ask about the thoughts and feelings of the characters) and is composed of seven sets of stimulus cards with three cards per set. The three pictures differ just enough to vary in emotional valence, usually by alteration in facial expressions and body postures of the characters.

Methods

We have compared FFT responses of 80 children aged from 6 to 12 years and divided into two groups (clinical group composed of children with learning disabilities versus control group). The aim of that exploratory study was to study three psychological important variables of the FTT: anxiety, depression and self-esteem levels.

Results

FTT indicators allow us to differenciate significatively (using Chi Square Method) the two groups’ distributions. Anxiety and depression levels are higher in the clinical group and self-esteem level was lower in the same group. These data suggest the interest to develop further FTT validation since the usefulness of that tool has been demonstrated in other countries such as Greece (Coulacoglou, 1996, 2008), Russia (Savina, 2008), China (Li and Zhang, 2008), India (Sanyal and Dasgupta, 2008) and Turkey (Ikiz-Ertem-Vehid-Düsgor, 2008).

Conclusion

Our preliminary study shows us FTT discriminant power to differenciate a group of children with learning disabilities compared to a control group for three important dimensions of personality: anxiety, depression and self-esteem levels. Now it is necessary to undertake further validation on FTT in France with several goals: larger samples, more contrasted clinical groups and evaluation of the other FTT indicators not studied in the present article.     

De l’usage rationnel à l’usage optimal des médicaments psychotropes auprès des enfants

The increasing use of psychotropic drugs raises various issues related to prevalence and characteristics of youth for whom medication is prescribed. Recent trends indicate that psychotropic medication and polypharmacy users are younger and that prescribing practices are often motivated by symptoms rather than diagnosis. The prescriber, as any practitioner, is called upon to make decisions in a context of uncertainty and limited rationality. That is why prescribing practices should be studied from a heuristic and systemic standpoint. First factors associated with the use of medication can be discussed in terms of knowledge gained from scholarly journals, research reports produced by the pharmaceutical industry and systematic reviews. The guidelines from medical associations, fields and reserved acts that define the medical identity and the notion of “responsibility” are elements which may also intervene in the decision to prescribe. Finally, an intervention can meet the contingencies of more local practice environments or the therapeutic relationship. That is why, in recent years, when it comes time to pay attention to prescribing practices in complex practice environments, the paradigm of optimal use may be relevant.     

Les changements institutionnels amenés par la loi de février 2005 pour l’égalité des droits et des chances,la participation et la citoyenneté des personnes handicapées

First, the author describes the changes produced by the 1975's law. A change of perspective on disability has been the source of the law of February 11, 2005. This has changed the relationship of children with disabilities with the school. In the MDPH, a personalized project of schooling is constructed. The articulation of the role of each stakeholder is taking place gradually. This leads to some important questions. The National Solidarity Fund for Autonomy supports activities that promote this articulation. Some of its actions are focused on assessing the needs of people.     

Place et enjeux de la formation des acteurs de santé auprès des adolescents

Teenagers’ Houses are a tremendous resource to bring professionals together on the questions of adolescence. They are meeting places, places of care and places of professional training too. After delimiting a new teenager's clinical comprehension, we describe the stead and the issues of the professional trainings of the health protagonists working beside teenagers. Being in charge of the “Teenager's Medicine and Health” Inter-University Degree, we detail the importance of these professional trainings. They are source of reassessments and evolution of the ways of thought. They are too source of dynamism, creativity and daring, indispensable for those who work beside teenagers.     

État des lieux des pratiques d’accompagnement sanitaire et médico-social des personnes avec troubles envahissants du développement (TED) dans trois régions françaises

Aim

This study is a component of the “French Autism Plan 2008–2010”. Its objective is to describe intervention and care practices proposed to people with pervasive developmental disorders (PDD) in three French regions (Île-de-France, Franche-Comté, Nord-Pas-de-Calais).

Method

Data were collected by a questionnaire adapted mailed to special education and health care services in three regions (quantitative data) and semi-structured interviews from a sample of professionals (qualitative data). A total of 254 questionnaires (163 from services for children and adolescents, 91 from services for adults) and 48 interviews (21 for children and adolescents, 27 for adults) were analyzed.

Results

Intervention and care practices described often lack of specificity and are not enough adapted to people with PDD, particularly in adults’ services. An improvement of practices is nevertheless evidenced, with the development of interventions centered on the development of communication or daily living skills and procedures to manage challenging behaviors, yet not generalized. Important efforts are made regarding training and partnership with ordinary settings. Professionals also wish to better take into account the person's and his family's point of view in the individualized program.

Conclusion

This study emphasizes lacks and improvement in intervention and care practices for people with PDD in France, and those data might be a useful basis to study the practices’ evolution in the future.     

Efficacité des biphosphonates oraux sur la déminéralisation osseuse des patients atteints de mucoviscidose

Disturbances in bone mineralization are frequent in cystic fibrosis but few studies have focused on the use of biphosphonates in this indication, and none on the use of oral etidronate. We report our experience using this latter treatment. METHODS: The study was retrospective and included five children and three adults with cystic fibrosis (six males and two females) aged seven to 30 years with Z-scores for lumbar bone density lower than -2 SD after one year of calcium (1 g/day) and vitamin D (900 UI/day and 300,000 UI/6 months) supplementation. All were treated during one year with etidronate: four courses of 15 days (one course per trimester) with doses ranging from 4 to 8 mg/kg per day. Calcium and vitamin D supplementation was continued between the etidronate treatment course. Total body and lumbar bone mineral density (BMD) were measured three times: at the beginning and the end of the year of calcium and vitamin D supplementation and at the end of the year of supplementation plus the four courses of etidronate treatment. RESULTS: The increase in BMD in absolute value (g/cm2) and in Z-score was significantly higher (P <0.05) after the year of combined supplementation and etidronate treatment (total body g/cm2: 3+/-1%, Z-score: 2+/-1% and lumbar spine g/cm2: 6+/-5%, Z-score: 3+/-4%) than after supplementation alone (total body g/cm2: -1+/-3%, Z-score: -4+/-3% and lumbar spine g/cm2: -1+/-3%, Z-score: -4+/-4%). Supplementation alone improved the total BMD in only one patient and the lumbar BMD in three, whereas after etidronate treatment the total and lumbar BMD were improved in the eight patients. None of the patients presented with side effects that could be attributed to the treatment. CONCLUSION: Oral etidronate treatment is well-tolerated and capable of improving bone mineralization in patients with cystic fibrosis. Further work will be necessary to determine the optimal dosage and the optimal frequency for the treatment series.