Je suis gros(se), parce que... Paroles de personnes en surpoids

Far from the discussions of prominent professionals who study or care for them, here, we present the personal accounts of overweight people on the reasons they have gained weight. This provides an avenue for better understanding and, perhaps, better prevention and treatment of the condition.     

The spectrum of seat belt syndrome among Canadian children: Results of a two-year population surveillance study

BACKGROUND

Seat belts have been proven to save lives. However, if they are not properly fitted, ‘seat belt syndrome’ can occur. The aim of the present study was to describe injuries encountered in Canadian children with seat belt-associated injuries.

METHODS

Canadian paediatricians and paediatric subspecialists were surveyed monthly through the Canadian Paediatric Surveillance Program. Children younger than 18 years of age who were restrained in motor vehicles at the time of a collision, with abdominal or thoracolumbar spine injuries, were included. The children may have been restrained in child safety seats, booster seats, or two- or three-point seat belts.

RESULTS

Twenty-eight children, between two and 16 years of age, with injuries compatible with seat belt syndrome were reported in Canada between September 2003 and August 2005. Although 12 children were younger than eight years of age, only one was restrained in a booster seat and only four of the older children were properly restrained with a three-point seat belt. Twenty-four children had abdominal injuries. Of these, 18 had stomach and/or intestinal injuries and 11 had solid organ injuries. Twelve patients had a spinal fracture, including only five Chance-type fractures. Seven patients presented with paraplegia, and none of them recovered.

CONCLUSION

In Canada, over a two-year period, 28 children were reported to have sustained injuries consistent with seat belt syndrome; seven of these children remained paraplegic. These results emphasize the necessity to review restraints in motor vehicles to adequately protect children.     

Surveillance of surgical site infections after digestive surgery

Objective

The authors had for aim to monitor surgical site infections (SSI) after digestive surgery and to compare local hospital rates to those of the south-east French region. The overall rate of SSI was compared to the rate of two targeted surgeries: cholecystectomy and hernia repair (CHOL, HERN).

Method

Surveillance of all surgical procedures, following “CCLIN Sud-Est” surveillance guidelines was carried out between June and August 2006.

Results

Three hundred and thirty-eight surgeries were included. Among them, 20 SSIs (5.92%) were diagnosed and confirmed by a surgeon. The univariate analysis identified six risk factors: age, wound classes (3 or 4), ASA (3 or 4 or 5), length of surgery (greater than two hours), complexity of surgery, and carcinologic surgery. In the multivariate analysis, ASA score and length of surgery were significantly linked to SSI. SSI rates for HERN and CHOL were respectively 2.7 (2/73) and 2.9% (2/68).

Conclusion

The overall rate of infection was high compared to the “CCLIN Sud-Est” 2005 data. However, teaching hospitals accounted for only 8% of all interventions and they usually hospitalize patients at risk. Thus, the overall follow-up requires stratifying the results in homogeneous groups of patients (NNIS) to have comparable results overtime and between hospitals. In addition, this monitoring is difficult to perform because it is a very time-consuming routine. However, if CHOL and HERN are more reliable for comparison and less time-consuming, they do not reflect the overall rate of SSI.     

Validation study of a nonspecific psychological distress scale

Background Psychological distress scales are often used in national epidemiological surveys to monitor the mental health status and predict demands in mental health services. These scales have the advantage of being easy to administer and inexpensive to use. The goal of this study is to assess the clinical validity of the Psychological Distress Manifestations Measure Scale (PDMMS) by comparing it to a standard criterion. Method The validation study is based on data from a large-scale mental health survey conducted in 1999 in the Montreal area (Canada). The target population was constituted of adults living in private households. A telephone survey was carried out with a probability sample of 4,704 respondents using the Composite International Diagnostic Interview Simplified (CIDIS) to detect mental disorders. Then, subsequent face-to-face interviews with a subsample of 359 of these respondents were conducted to validate other measures for assessing mental health needs for care and services including the PDMMS. Results Our study showed that high psychological distress is highly associated with mental disorder (OR=5.94). However, a large majority of the people in the high psychological distress category does not have a known mental problem. Conclusions These data confirm that like other psychological distress scales, the PDMMS is not a diagnostic tool. Rather, it is designed to explore comorbidity among symptoms, independent of caseness. The prevalence of psychological distress in the population allows us to identify people who have subclinical symptoms substantial enough to precipitate dysfunctioning in everyday life and who utilize health services more frequently. The use of this tool for epidemiological surveys is useful for mental health service planning because it provides information on the needs of individuals whose state of mental health affects social functioning even though they do not suffer from pathology.     

Transplantation auxiliaire pour cirrhose: Une alternative possible pour l’utilisation de greffons de petit poids ?

If the ratio liver graft weight/recipient body weight ratio is below 0.8%, there is a high risk of primary non function of the graft in almost 50% of cases. We report the first elective Auxiliary Partial Orthotopic Liver Transplantation using a small cadaveric left graft for cirrhosis. The graft weight/recipient body weight rate was 0.6%. This technique avoided the small-for-size syndrome in the early postoperative period. The native right liver was resected two months later. With a follow-up of 5 years, the patient is in good condition. This original technique could be a solution to increase the number of transplantations using small grafts, especially left grafts, provided by splits or living donors.