Optimisation de la prise en charge médicale des patients sortant de prison au Luxembourg

Le passage en prison peut être un gain de chance pour la santé de la population carcérale qui a généralement un faible accès au système de soins. L’élargissement de prison peut devenir une période de vulnérabilité où ce gain potentiellement acquis s’annule si la transition vers la société civile n’est pas anticipée. L’objectif principal était l’identification et l’analyse des facteurs qui favorisent et s’opposent à une pratique de soins primaires chez les patients sortant du milieu carcéral au Luxembourg. L’objectif secondaire était l’élaboration de recommandations à l’égard des principaux résultats en s’appuyant sur une revue de la littérature. Méthodes : Une enquête qualitative à l’aide d’entretiens semi-dirigés a été menée auprès de médecins généralistes et de patients-détenus. Les questions des deux guides d’entretien étaient semblables afin que l’analyse permette une mise en miroir des résultats. Un recueil des caractéristiques sociodémographiques a également été effectué. A l’aide de la transcription des entretiens, une analyse de contenu thématique catégorielle de ces derniers a été réalisée au regard des objectifs. Sur base des verbatim, des items ont été formulés et regroupés en dimensions puis en thèmes. Résultats : Notre analyse a mis en lumière le manque de relais entre la prison et l’extérieur à chaque étape de la prise en charge médico-psycho-sociale du point de vue des soins et des aides proposées en prison jusqu’à l’élargissement. Des recommandations concernant des améliorations possibles ont pu être proposées, comme la création d’un réseau de médecins généralistes prenant le relais ainsi qu’une véritable coopération avec des organisations prenant en charge des toxicomanes. Conclusion : Des reformes concernant les soins en prison devraient être envisagées entre le système de l’élargissement, la création de relais socio-médicaux et des alternatives à l’incarcération, en analogie aux transitions clinics retrouvés aux États-Unis

Remote training as a common tool for the different professionals involved in the acute phase after terror attacks across Europe:Perspectives from an expert panel

The acute response after a terror attack may have a crucial impact on the physical and psychological wellbeing of the victims. Preparedness of the professionals involved in the acute response is a key element to ensure effective interventions, and can be improved through trainings. Today in Europe there is a recognized lack of inter-professional and international trainings, which are important, among others, to respond to the needs and the rights of victims affected by a terrorist attack in another country than their home country. In this paper we report the perspectives of an expert panel composed by different categories of professionals on the possible role of interprofessional trainings provided remotely. The experts discussed the pertinence of remote trainings for professionals involved in the acute response of a terror attack, and highlighted their Strengths, Weaknesses, Opportunities and Threats (SWOT analysis). We concluded that, while remote trainings cannot replace in-person trainings, they may be useful to share knowledge about the role and the organization of the different categories of professionals, thus potentially improving response coordination, and to easily share good practices across professionals and countries

Early Phase Psychiatric Response for Children and Adolescents After Mass Trauma: Lessons Learned From the Truck-Ramming Attack in Nice on July 14th, 2016

Recent years have seen a multiplication of terrorist attacks in public places across European and North American countries, thus heightening the need for public mental health planning and response strategies focused on the special needs of children and their families. The present article retrospectively analyzes the early phase psychiatric response for children and adolescents after the truck attack in Nice on July 14th, 2016. In addition, lessons which can be drawn from it will be discussed, with a focus on organizational challenges in the early phase. During the first 2 weeks after the attack, 668 individuals have been registered at the medico-psychological emergency unit of the Children's Hospitals of Nice, including 365 (54.6%) children and adolescents of all ages. Overall, 146 child and adolescent mental health care professionals participated in this specific facility, including 75 psychiatrists and psychologists. The implementation of the medico-psychological emergency unit dedicated to the pediatric population has been an indispensable and unprecedented public health challenge in our country. Future studies are needed in order to evaluate and to improve the efficiency of the individual as well as collective impact of early phase psychiatric interventions dedicated for children and adolescents after mass trauma

Bridging health technology assessment (HTA) with multicriteria decision analyses (MCDA): field testing of the EVIDEM framework for coverage decisions by a public payer in Canada

<p>Abstract</p> <p>Background</p> <p>Consistent healthcare decisionmaking requires systematic consideration of decision criteria and evidence available to inform them. This can be tackled by combining multicriteria decision analysis (MCDA) and Health Technology Assessment (HTA). The objective of this study was to field-test a decision support framework (EVIDEM), explore its utility to a drug advisory committee and test its reliability over time.</p> <p>Methods</p> <p>Tramadol for chronic non-cancer pain was selected by the health plan as a case study relevant to their context. Based on extensive literature review, a by-criterion HTA report was developed to provide synthesized evidence for each criterion of the framework (14 criteria for the MCDA Core Model and 6 qualitative criteria for the Contextual Tool). During workshop sessions, committee members tested the framework in three steps by assigning: 1) weights to each criterion of the MCDA Core Model representing individual perspective; 2) scores for tramadol for each criterion of the MCDA Core Model using synthesized data; and 3) qualitative impacts of criteria of the Contextual Tool on the appraisal. Utility and reliability of the approach were explored through discussion, survey and test-retest. Agreement between test and retest data was analyzed by calculating intra-rater correlation coefficients (ICCs) for weights, scores and MCDA value estimates.</p> <p>Results</p> <p>The framework was found useful by the drug advisory committee in supporting systematic consideration of a broad range of criteria to promote a consistent approach to appraising healthcare interventions. Directly integrated in the framework as a "by-criterion" HTA report, synthesized evidence for each criterion facilitated its consideration, although this was sometimes limited by lack of relevant data. Test-retest analysis showed fair to good consistency of weights, scores and MCDA value estimates at the individual level (ICC ranging from 0.676 to 0.698), thus lending some support for the reliability of the approach. Overall, committee members endorsed the inclusion of most framework criteria and revealed important areas of discussion, clarification and adaptation of the framework to the needs of the committee.</p> <p>Conclusions</p> <p>By promoting systematic consideration of all decision criteria and the underlying evidence, the framework allows a consistent approach to appraising healthcare interventions. Further testing and validation are needed to advance MCDA approaches in healthcare decisionmaking.</p

MODELOS ANALÍTICO-NUMÉRICOS PARA INTERAÇÃO DINÂMICA VEÍCULO-PAVIMENTO-ESTRUTURA

Este trabalho tem por objetivo a comparação entre resultados obtidos de duas modelagens para interação dinâmica veículo - pavimento - estrutura de ponte: uma em que a estrutura é representada por modelo numérico unifilar e a solução é modal e outra em que o tabuleiro da ponte é modelado por elementos finitos de casca sendo a solução do problema efetuada em coordenadas nodais. Os modelos foram aplicados a uma estrutura de ponte que representa grande parte das obras de arte brasileira, sob a passagem de um veículo de três eixos em distintas condições do pavimento. Os resultados em termos de deslocamento mostram uma boa correlação entre os métodos, desde que os dois tipos de modelo numérico da estrutura representem de forma equivalente as propriedades dinâmicas associadas aos modos de vibração determinantes no comportamento da ponte sob a ação da passagem de veículos

Intra-uterine growth restriction and the programming of left ventricular remodelling in female rats

Epidemiological studies link intra-uterine growth restriction (IUGR) with increased incidence of hypertension and cardiac disease in adulthood. Our rat model of IUGR supports this contention and provides evidence for the programming of susceptibility for hypertension in all offspring. Moreover, in the female offspring only, gross anatomical changes (cardiac ventricle to body ratios) and increased left cardiac ventricular atrial natriuretic peptide (ANP) mRNA levels provide evidence for programming of cardiac disease in this gender. The aim of the current study was to measure changes in cardiac tissue that support remodelling that could be implicated in the initiation of hypertrophy. Adult female rats from our IUGR model and age- and sex-matched controls were killed at 12 weeks of age. Left cardiac ventricles were removed and used for monitoring changes in several key genes, Na(+),K(+)-ATPase β1 protein expression, cardiomyocyte morphology and contractility as well as citrate synthase and aconitase activities. When compared to controls, female offspring of our IUGR rat model exhibit higher expression (mRNA) of ANP and the atrial isoform of the myosin light chain, lower levels of Na(+),K(+)-ATPase β1 protein, increased cardiomyocyte depth and volume, increased sarcomere length, diminished cardiomyocyte contractility and lower aconitase activity. Female offspring of our IUGR rat model exhibit changes as adults that are consistent with the onset of cardiac remodelling. The decrease in aconitase activity suggests that oxidative stress may be implicated in this response

Relation between Shear Stresses and Flexural Tensile Stresses from Standardized Tests of Extracted Prismatic Specimens of an SFRC Bridge Girder

Experimental research on the direct shear behavior of fiber-reinforced concrete is often carried out using prisms molded with specific dimensions for a standardized test. However, the flow of fresh concrete in these molds can be different than in the case of a full-scale structural element. This is important considering that the flow direction highly influences the distribution and orientation of fibers. In addition, most of the studies did not relate their shear results to other mechanical properties. In contrast, this study attempted to deepen the experimental knowledge of the crack propagation of a steel fiber-reinforced concrete (SFRC) used in a full-scale prototype of a bridge box girder built in the laboratory. Prismatic specimens were sawn from webs and top flanges of this prototype. Serving as references, additional specimens were molded in wooden boxes. In a previous study of our research group, both had been tested under a three-point notched bending configuration maintaining test conditions proportional to the EN14651 specifications. From each of the previously flexurally tested specimens, two prismatic specimens suitable for the Fédération Internationale de la Précontrainte (FIP) shear test setup were extracted by adopting a cutting methodology that avoided the damage induced by the flexural tests to be part of the FIP specimens. These FIP specimens were tested in almost pure shear loading conditions for assessing the performance of SFRC. Computer tomography images and photos of the shear failure faces were used to determine the distribution and density of fibers. The results demonstrated that the peak loads were proportional to the fiber density at the shear failure section. Assuming that the SFRC conditions of the webs were representative of a common batching procedure in the construction industry, the results from the tests in specimens extracted from these webs were adopted to establish shear stress/flexural tensile stress ratios vs. crack mouth opening displacement curves. The curves belonging to cross-sections of a similar fiber density in the shear and flexural cases allowed for the proposal of a normalized crack-dilatancy relation composed of three stages of the crack propagation. In addition, a trilinear crack width–slip relation was established using the same set of specimens. The relevancy of this proposal is that the shear response can be estimated from a widely accepted standardized flexural test, which demands a simpler instrumentation and is also easier to execute than the shear setup