The use of the brunet lezine scale for the cognitive and motor assessment of patients with profound and multiple disabilities

ObjectivesTo date, there is no validated tool allowing the assessment of cognitive and motor capacities of patients with polyhandicap (PLH) because of their profound and multiple disabilities because of their severe mental deficiencies and motor handicaps, as well as their extremely low possibilities to communicate. However, as these patients hardly ever reach the cognitive and motor development of infants older than two years, we hypothesized the level of their development may be assessed by means of an adapted version of the Brunet-Lézine (BL) Scale. Therefore, the aim of this study is to estimate the relevance of the use of the Brunet-Lézine Scale among PLH patients.PatientsForty patients (21 males and 19 females aged 4 to 54) were enrolled in two specialized French Rehabilitation Centers. They were all PLH patients with a combination of motor (pyramidal, extra pyramidal, cerebellar, neuromuscular) deficiencies and a profound mental retardation (IQ could not be assessed); they fully depended on caregivers for their everyday needs (FIM<30) and they had a very restricted mobility (GMFCS II to V).MethodsThe relevance of the use of Brunet-Lézine Scale among PLH patients was first assessed by describing the distribution of patients’ scores on the four dimensions of the scale. Then the structure of the scale was verified and the convergence of the scores at this scale with other relevant – while not sufficient – scores was assessed: FIM, GMFCS, and a clinical evaluation of sociability and verbalization by another independent caregiver.ResultsPLH patients tend to present low scores on the Brunet-Lézine Scale, which correspond to early developmental stages. Among PLH patients, it sounds more relevant to group the four dimensions of the Brunet-Lézine into two factors: motor activity (posture and coordination) and social interactions (language and sociability).Discussion/conclusionConvergence analyses suggest that the motor and social development of PLH patients may be reliably estimated by means of the Brunet-Lézine Scale

Psychiatric and psychological follow-up of undergraduate and postgraduate medical students: prevalence and associated factors. Results from the national BOURBON study. Running title: mental health and addictive behavior of medical students

International audienceBackgroundPhysicians are at risk of burnout, anxiety and depression. Prevention is needed from the beginning of the medical studies to detect early poor mental health outcomes.ObjectiveTo determine the prevalence and associated of psychiatric or psychological follow-up in a national sample of undergraduate and postgraduate medical students (UPMS).MethodsUPMS of the 35 French Medicine faculties were recruited through mailing lists and social networks between December 2016 and May 2017 and fulfilled Internet anonymised questionnaires.ResultsOverall, 10,985 UPMS were included in the present study (2165 (19.7%) postgraduate, 31.6% males, mean aged 21.8 years). Overall, 1345 (12.2%) were followed-up by a psychiatrist and/or a psychologist, 20.5% of them were regular anxiolytic consumers and 17.2% of them were regular antidepressant consumers. In multivariate analyses, being followed-up by a psychiatrist and/or psychologist was associated with older age (aOR = 1.2[1.2–1.2], p < 0.0001), female gender (aOR = 0.5[0.5–0.7], p < 0.0001), current alcohol use disorder (aOR = 1.3[1.3–1.5], p < 0.0001), higher anxiolytic (aOR = 3.1[2.5–3.7],p < 0.0001) and antidepressant (aOR = 11.7[7.6–18.0],p < 0.0001) consumption, and with lower self-reported general health, social functioning and mental health quality of life (all aORs = 0.9, all p < 0.05). The UPMS followed-up by psychiatrist and/or psychologist reported to have been more frequently exposed to sexual assault (5.1% vs. 0.9%, aOR = 2.5[1.3–4.7], p < 0.0001), domestic violence (3.3% vs. 0.8% aOR = 2.1[1.2–4.0], p = 0.01) and parents divorce (11% vs. 6.4%, aOR = 1.5[1.2–1.9], p = 0.001). Students followed-up by a psychiatrist and/or psychologist reported more frequently to seek alleviating anxiety (aOR 1.9[1.6–2.3], p < 0.0001), depression (aOR 1.7[1.3–2.1],p < 0.0001), coping with studies difficulties (aOR 1.5[1.2–1.8],p < 0.0001), experiencing more stress at hospital (aOR = 2.3[1.6–3.5],p < 0.001) and more burnout syndrome (aOR = 1.4[1.1–1.8], p = 0.03).ConclusionsAround 12% of UPMS are followed-up by a psychiatrist and/or a psychologist. These students reported higher antidepressant and anxiolytic consumption, psychic suffering and altered quality of life, associated with professional pressure and personal issues. Public health programs should be developed to help these students through their studies to prevent later mental /addictive issues and professional suffering. Improving UPMS mental health may also improve the later quality of care of their patients and global stress at hospital

Improving the treatment and remission of major depression in homeless people with severe mental illness: the multicentric French Housing First (FHF) program. French Housing First Study Group Running title: Major depression in homeless people with severe mental disorders

International audienceObjectiveThe aim of this study was to investigate the factors associated with violent behavior in a large multicenter sample of Homeless Schizophrenia (SZ) and Bipolar Disorder (BD) (HSB) subjects.MethodsThis multicenter study was conducted in 4 French cities: Lille, Marseille, Paris and Toulouse. Violent behavior was defined by at least one episode of verbal or physical violence in the last 6 months.ResultsOverall, 675 HSB patients, mean aged 38 years and 82.5% men were included, 458 SZ (68.4%) and 212 BD (31.6%). During the 6 months before evaluation, 213 (34.3%) committed at least one physical or verbal violence. In multivariate analysis, violence has been associated with younger age (aOR = 0.96[0.94–0.99], p = .001), number of nights in the street (aOR = 1.01[1.01–1.01]), BD diagnosis (aOR = 1.63[1.01–2.65], p = .04), higher current illness severity (CGI score) (aOR = 1.32[1.07–1.64], p = .01), higher rates of current manic episode (aOR = 2.24[1.32–3.81], p = .002), current alcohol use disorder (aOR = 2.05 [1.33–3.15], p = .001), antisocial personality disorder (aOR = 2.51[1.55–4.07], p < .001) and with antidepressant consumption (aOR = 2.01[1.01–4.04], p = .04). No specific antipsychotic or mood stabilizer has been associated with decreased rates of violent behavior, however clozapine, lithium and carbamazepine remained poorly prescribed.ConclusionIn case of violent behavior in HSB subjects, clinicians should focus in priority on the treatment of mania, antidepressant iatrogenic effect and alcohol use disorder by pharmacological and non-pharmacological treatments. Clozapine, lithium and carbamazepine should be chosen as the treatments of reference in this population but may be hard to manage in some cases.The current clinical trial number is NCT01570712

First-year French medical students consume antidepressants and anxiolytics while second-years consume non-medical drugs.

International audienc

DEVELOPMENT and ACCEPTABILITY of A NEW INTERNATIONAL QUALITY of LIFE INSTRUMENT SPECIFIC TO PHYSICAL APPEARANCE: BEAUTYQOL

Data Min Int, Geneva, SwitzerlandLab Sante Publ, Marseilles, FranceNatl Ctr Sci Res, Villeurbanne, FranceUniv Utah, Hlth Sci Ctr, Salt Lake City, UT USAUniversidade Federal de São Paulo, São Paulo, BrazilUniv Tokyo, Bunkyo Ku, Tokyo 113, JapanLOreal Int, Asnieres, FranceUniv Paris 06, Paris, FranceUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

International development of the first quality of life instrument specific to cosmetology and physical appearance: the BeautyQol initiative

Data Mining Int, Geneva, SwitzerlandLab Sante Publ, Marseilles, FranceNatl Ctr Sci Res, Lyon, FranceUniversidade Federal de São Paulo, São Paulo, BrazilUniv Tokyo, Tokyo, JapanLoreal Int, Asnieres, FranceUniv Paris 06, Paris, FranceUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Europeans’ willingness to pay for ending homelessness: A contingent valuation study

The purpose of this study is to assess the utility value European citizens put on an innovative social program aimed at reducing homelessness. The Housing First (HF) model involves access to regular, scattered, independent and integrated housing in the community with the support of a multidisciplinary team. Currently, HF is not implemented by most European countries or funded by healthcare or social plans, but randomised controlled trials have stressed significant results for improved housing stability, recovery and healthcare services use. The broader implementation of HF across Europe would benefit from a better understanding of citizens' preferences and “willingness to pay” (WTP) for medico-social interventions like HF. We conducted a representative telephone survey between March and December 2017 in eight European countries (France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden). Respondent's WTP for HF (N = 5631) was assessed through a contingent valuation method with a bidding algorithm. 42.3% of respondents were willing to pay more taxes to reduce homelessness through the HF model, and significant differences were found between countries (p < 0.001); 30.4% of respondents who did not value the HF model were protest zeros (either contested the payment vehicle-taxes- or the survey instrument). Respondents were willing to pay €28.2 (±11) through annual taxation for the HF model. Respondents with higher educational attainment, who paid national taxes, reported positive attitudes about homelessness, or reported practices to reduce homelessness (donations, volunteering) were more likely to value the HF model, with some countries' differences also related to factors at the environmental level. These findings inform key stakeholders that European citizens are aware of the issue of homelessness in their countries and that scaling up the HF model across Europe is both feasible and likely to have public support

BMC Nephrol

BACKGROUND: To describe the quality of life of adolescents initiating haemodialysis, to determine the factors associated with quality of life, and to assess coping strategies and their impact on quality of life. METHODS: All adolescents initiating haemodialysis between September 2013 and July 2015 in French paediatric haemodialysis centres were included. Quality of life data were collected using the "Vecu et Sante Percue de l'Adolescent et l'Enfant" questionnaire, and coping data were collected using the Kidcope questionnaire. Adolescent's quality of life was compared with age- and sex-matched French control. RESULTS: Thirty-two adolescents were included. Their mean age was 13.9 +/- 2.0 years. The quality of life score was lowest in leisure activities and highest in relationships with medical staff. Compared with the French control, index, energy-vitality, relationships with friends, leisure activities and physical well-being scores were significantly lower in haemodialysis population. In multivariate analyses, active coping was positively associated with quality of life and especially with energy-vitality, relationships with parents and teachers, and school performance. In contrast, avoidant and negative coping were negatively associated with energy-vitality, psychological well-being and body image for avoidant coping, and body image and relationships with medical staff for negative coping. CONCLUSIONS: The quality of life of haemodialysis adolescents, and mainly the dimensions of leisure activities, physical well-being, relationships with friends and energy-vitality, were significantly altered compared to that of the French population. The impact of coping strategies on quality of life seems to be important. Given the importance of quality of life and coping strategies in adolescents with chronic disease, health care professionals should integrate these aspects into care management