Evaluation of Eye Movement Desensitization and Reprocessing in the management of tinnitus. An observational study

ObjectivesTinnitus can induce disabling psychological suffering, requiring an integrative multimodal approach, combining neuromodulation and psychotherapeutic methods. We sought to evaluate the therapeutic efficacy and acceptability of Eye Movement Desensitization and Reprocessing (EMDR) in tinnitus.Materials and methodsThis was a single-center prospective non-comparative study. Inclusion criteria comprised: adult patient, with chronic tinnitus, Tinnitus Handicap Inventory (THI) score > 17, causing psychological distress motivating active treatment after ineffective “classic” treatment (combining advice, sound therapy and first-line drug treatment), and agreement to EMDR therapy. Therapeutic efficacy was defined by a decrease in THI or Visual Analog Scale (VAS) scores. Treatment acceptability was defined by the rate of included patients who completed therapy.ResultsThirty-eight patients were included. There was a significant reduction of 53.5% in THI score in 78.9% of patients (P < 0.0001; 64.8 ± 20.8 before versus 31.8 ± 24.7 after treatment), and of 51% in VAS score in 76.3% of patients (P < 0.0001; 7.24 ± 2.12 before versus 3.58 ± 2.03 after treatment). The treatment acceptability was 86.8%.ConclusionEMDR appeared to be an effective alternative that was acceptable to the majority of patients, after failure of “classic” first-line treatment, improving quality of life in tinnitus patients and thus relieving disability.     

L’espace de la santé mentale : un paysage discursif et clinique en remaniement

Objectives

This paper introduces some epistemology about mental health developments and how it leads to reconsider the landscape of clinical practices.

五类残疾儿童现患调查与康复需求分析

目的：了解儿童残疾的发生率，致残原因及康复需求。方法：采用整群随机抽样调查的方法。对5000名0-6岁儿童进行听力、视力，肢体、智力及精神5方面的调查，统一培训调查人员，调查结果经统计学处理分析。结果：五类残疾儿童共59人，单残43人，混合残16人，残疾发生率为1.18%。残疾顺位为智力63.16%，肢体18.42%，听力7.89%，精神6.58%，视力3.95%。致残原因孕期和产时因素50.8%，原因不明28.8%，遗传及先天性疾病因素8.2%，小婴儿时生病12%，偶有意外伤害。59名残疾儿童仅有21例采取不同程度康复措施。结论：加强围产期保健，对具有高危因素的婴儿实行监控和早期干预，开展残疾儿童康复服务，是减少和预防残疾儿童的发生率，降低残疾程度提高人口素质的关系。     

Dysphagia,an unrecognized handicap

The aim of this study was to examine whether esophageal dysphagia can be described as a handicap and to grade the severity of handicap as the discrepancy between the subject's own eating goals and his or her eating disability. The severity of the disability-goal-handicap (DGH) regarding dysphagia was expressed on a scale ranging from 0 to 48 points. Nineteen patients with dysphagia of differing causes were selected from a patient register at a laboratory for diagnostic procedures of the esophagus. The severity of handicap for the 19 patients was, on average, 33 points (range, 20–44). The DGH score correlated significantly with the patients' own evaluation of the severity of their dysphagia (p=0.008). The DGH scores did not differ markedly based on patient's sex, age, or cause of dysphagia. Patients who were operated upon because of dysphagia had significantly more points on the DGH scale prior to operation than patients who were not (p=0.001). Denial of dysphagia (N=18), concealment of dysphagia (N=18), and lack of confirmation by the patient's physician (N=15) were common but did not influence the severity of handicap as assessed by the DGH scale. It was shown that dysphagia affects all aspects of life as expressed by reduction in self-esteem (N=13), security (N=16), work capacity (N=8), exercise (N=7), and leisure time (N=6). Esophageal dysphagia may therefore be regarded as a handicap when assessed using the DGH code described in this study.     

Réhabilitation psychosociale en France

The concept of psychosocial rehabilitation and the various practices it involves appeared in North America in the eighties. In France the sectorization policy of mental health care included from the beginning such notions as readaptation and rehabilitation. However, it has been difficult to distinguish between general care for mental patients and rehabilitation as such. We shall, in this presentation, give a brief summary of the modern aspects of psychosocial rehabilitation and summarize how they have been developed in France over the last years.     

The “employability” of disabled people in France: A labile and speculative notion to be tested against the empirical data from the 2008 “Handicap-Santé” study

Following the passage of the French law of 2005 on equal rights and opportunities, the issue of the “employability” of disabled people became a matter of public discussion. To clarify the debate, the article briefly presents the evolution of this notion and its various meanings, from the social sphere to employment policies. The concept of “employability” is then examined without any preconceived definition using empirical data from the national “Handicap-Santé” (disability-health) survey carried out in 2008 on the general population in France. Five groups illustrate employment patterns, social protection devices and types of disability: remaining employed until retirement; being employed thanks to social systems; leaving employment through “incapacity for work” systems; being employed through one's own resources; and being in sheltered employment or inactive. This construct provides keys to understand how “employability” manifests itself. The results show that, unlike the vision of employability that is focused on individual characteristics and promoted by employment policies in Europe, addressing employability in the domain of disability is only meaningful when considering individuals in their environments. The results also show that disability systems encourage forms of employability but still appear to favour access to inactivity through “incapacity for work”.     

Bacteremia in the Spinal Cord Injury Population

Abstract

Positive blood cultures were found in 41 patients on the Spinal Cord Injury Service at the Milwaukee VAMC during the period of July, 1980 to December, 1985 giving an incidence of bacteremia of 1.3%. Mortality rate was 17%. Most common pathogens were E. Coli, Proteus mirabilis, Serratia marcescens and Staphylococcus aureus. A review of 29 available charts revealed genitourinary and respiratory tracts as the most common sources of infection (72.4% and 10.3% respectively). Other sources of infection were skin, postoperative, intravenous catheter site and cellulitis. Initial febrile response was seen in 93.1% of patients with 48.1% having temperature greater than 38.3°C. Hypotension (blood pressure less than 90/50 mm Hg) was noted in five out of the 29 (17.1%) patients. Clinical diagnosis of disseminated intravascular coagulation was made in two out of the 29 (6.9%) patients. Underlying risk factors were poor nutrition, respirator dependency, indwelling Foley catheters and manipulative procedures. Incidence and mortality rates are similar to the non-SCI population as reported elsewhere. The risk factors are different; therefore preventive management is extremely important.     

Comment rendre l’éthique accessible aux professionnels impliqués dans la prise en charge de l’enfant atteint de handicap ? Notre expérience en Rhône-Alpes

In France, the Rhône-Alpes Regional Network working on children's reeducation and rehabilitation brings together professionals involved in the care of children and teenagers with disabilities. These professionals are, daily, facing dilemmas that involve therapeutics decisions and the wishes or desires of the child and/or of his family. At first, at the Network's seminar in 2011, two clinical situations described were analysed by the philosopher Catherine Perrotin in the light of ethics. The exchanges that took place then showed the interest of thinking about the clinical situations which are dealt with on the field, with the help of someone from outside. In order to pursue this questioning, the network's ethics committee organised ethical exchanges in a coffee shop, which were called “ethics coffee”. Until now, six “ethics coffees” have taken place in Lyon. Each was built on a topic chosen by the ethics committee and inspired from clinical situations ; they involved a speaker who was invited by the Committee to bring a new light on the chosen topic. These “ethics coffees” became a learning space as well as a space for individual and collective questioning, which enables all professionals of the network to get to know and use tools serving the ethical approach in their daily practice.