Senegal: Presidential elections 2019 - The shining example of democratic transition immersed in muddy power-politics

Whereas Senegal has long been sold as a showcase of democracy in Africa, including peaceful political alternance, things apparently changed fundamentally with the Senegalese presidentials of 2019 that brought new configurations. One of the major issues was political transhumance that has been elevated to the rank of religion in defiance of morality. It threatened political stability and peace. In response, social networks of predominantly young activists, created in 2011 in the aftermath of the Arab Spring focused on grass-roots advocacy with the electorate on good governance and democracy. They proposed a break with a political system that they consider as neo-colonialist. Moreover, Senegal’s justice is frequently accused to be biased, and the servility of the Constitutional Council which is in the first place an electoral court has often been denounced

Facteurs de risque de survenue indésirables médicamenteux chez le sujet âgé hospitalisé dans une unité spécialisée dans la prise en charge des maladies démentielles

REIMS-BU Santé (514542104) / SudocSudocFranceF

Dépistage de la fragilité du sujet âgé à domicile : validation de l'outil SEGA modifiè

REIMS-BU Santé (514542104) / SudocSudocFranceF

Le rôle du support social sur le devenir de personnes âgées hospitalisées via les urgences

REIMS-BU Santé (514542104) / SudocSudocFranceF

Analyse de la fragilité du sujet âgé au travers de la mortalité dans la cohorte SAFES (Sujet âgé fragile-évaluation et suivi)

REIMS-BU Santé (514542104) / SudocSudocFranceF

Relevance of Aerodynamic Evaluation in Parkinsonian Dysarthria

Parkinsonian dysarthria is generally known under the name of hypokinetic dysarthria. Dysarthria, according to Darley et al (1969), is characterized by all speech disorders related to disturbances of muscular control of the speech organs, whose origin is a central or peripheral nervous system injury. So we must understand by dysarthria all failures related to either different levels of speech production (respiratory, phonatory, articulatory and even prosodic). Parkinsonian dysarthria, meanwhile, is mainly based on rigidity and hypokinesia. That's why it is considered as « hypokinetic » (Darley et al., 1975; Gentil et al., 1995). This term refers not only to reduction of articulatory movements but also to decreasing of speech prosody modulation described as monotonic (Viallet & Teston, 2007). Parkinsonian dysarthria arises, like other signs of Parkinson's disease, the depletion of dopamine in charge of phonatory incompetence by muscular hypokinesia. It is a major handicap factor that may compromise in long-term oral communication of the patient, as worsening over the course of the disease, responding less well to treatment and thereby posing additional difficulties in support. So we thought to better assess this dysarthria in order to gain a better understanding and improve management. This assessment can be done by perceptual analysis. She could also be done by various instrumental methods (acoustic and physiological) focusing on one of the speech production levels mentioned above. Such studies are numerous in literature and we will report some examples in this chapter. What is more rare in literature is assessment of parkinsonian dysarthria in study combined several levels as might allow, for example, the dual approach appealing to physiology of speech production with firstly an aerodynamic component related to pneumophonic coordination (respiratory and phonatory levels) and, secondly, an acoustic component in relation to phonoarticulatory coordination (phonatory and articulatory levels). Through this chapter we want show that it is possible to assess appropriately parkinsonian dysarthria by using aerodynamic parameters that combine respiratory and phonatory levels, so such an experiment that we report in this chapter after having reviewed main methods of evaluation.Ce travail met en évidence l'intérêt des mesures aérodynamiques pour l'évaluation de la dysrthrie parkinsonienne

Identification de facteurs associés à un faible recours aux soins spécialisés en psychiatrie. À propos de 516 cas d'expertises psychiatriques réalisées dans le cadre du Comité médical départemental de Martinique

International audienceObjective: Mental illness is noted for being in one of the first places in global burden of disease in terms of years lived with disability (YLDs). Notably, absences due to mental health problems greatly affect the world of work, and mental illness is one of the most economically important diseases. However, there is a high rate of those not seeking care in mental health, both in the general population but also in workers in private and public sectors with significant economic impacts. The aim of our study was to identify factors associated with low access to specialized psychiatric care among French Public Sector employees referred to a psychiatric expertise upon request from the Departmental Medical Board of Martinique (Comité médical départemental [CMD] de Martinique), between 2000 and 2013. Methods: We carried out an observational and transversal study, analyzing sociodemographic and clinical data from psychiatric assessments done to help the CMD give notification on the medico-administrative situation of Public Sector employees, a large majority of whom had been on sick leave due to mental health for at least 6 months. The variable of interest – low access to psychiatric care – was defined as the absence of consultation at the time of the assessment provided by a psychiatrist since at least 12 months. Descriptive analyses were performed first, then univariate analysis using a non-adjusted binary logistic regression model, to identify factors associated with low access to psychiatric care. Finally, multivariate analyses using a binary logistic regression model were performed after excluding non-relevant factors (with significance level above 5%) during the univariate analysis. A significance threshold of 0.05 was adopted for all of the statistical analyses. Results: We retrospectively analysed the records of 516 Public Sector employees. Two hundred and ninety-three subjects (57% of the population) had a low access to psychiatric care as part of their regular clinical follow-up, even the 81% who were identified has having had psychiatric antecedents (55% with ‘mood disorders’, and 17% with ‘neurotic, stress-related and somatoform disorders’). Moreover, psychiatric expertise found a psychiatric diagnostic in 96 % of cases, mostly ‘mood disorders’, ‘neurotic, stress-related and somatoform disorders’ and ‘personality disorders’. For mood disorders, clinical characteristics of episodes were defined as ‘severe’ or ‘with psychotic symptoms’ in many cases. Suicidal thoughts were found in 96 subjects (18%) during the expertise. Fewer than half of the subjects (43%) had a specialized psychiatric care (mostly subjects with ‘mood disorders’ and ‘psychotic disorders’) and 41% only had care by a general practitioner (mostly subjects with ‘neurotic, stress-related and somatoform disorders’). In most of the cases, psychotropic drugs were insufficiently and inadequately prescribed. Using multivariate analysis, we found a significant association between low access to psychiatric care and: being masculine, having had more than two children, having had personal life events (in particular chronic somatic diseases), and having had no history of mental illness or of psychiatric hospitalization. It appears that chronic somatic diseases are frequently associated with psychiatric diseases, and the association worsens the prognosis of the two disorders. However, even if employees with mental disorders associated with chronic somatic diseases are unfit for work, many of them do not have access to mental health care and only have care by a general practitioner. Conclusion: More than half of French Public Sector employees referred to the Departmental Medical Board of Martinique for a medico-administrative decision relevant to sick leave due to mental diseases, had low access to specialized psychiatric care. By identifying barriers to care and reasons for not seeking specialized mental health care, we would be able to prevent disability claims and days off work (predicting malaise in the workplace and health-related limitations). Our results demonstrate the need to strengthen existing partnerships, and thus enhancing cooperation between public psychiatric sectors and primary healthcare players, facilitating access to mental healthcare and decreasing the stigma about mental disorders

Occupational Risk Factors for COPD: A Case-Control Study.

The aim of this research was to examine the occupational risk factors for Chronic Obstructive Pulmonary Diseases (COPD) in a range of occupations.Eleven occupations involving different types of exposure were observed in this multicenter case-control study. Controls and cases were matched for sex, age and smoking. Multiple logistic regression analyses were used to estimate odds ratios (ORs).A total of 1,519 participants were initially recruited between September 2004 and September 2012. After matching, 547 pairs were obtained. The mean age was 56.3 +/- 10.4 years. Smelter workers were the only ones with an increased risk of COPD in this study (OR = 7.6, p < 0.0001, 95% CI [4.5, 12.9]). Physical activity was protective (OR = 0.7), while living in the city was a risk (OR = 1.6). The main used metals were cast iron, aluminum and alloys. Molds and cores were mainly made from sand and synthetic resins. Machine maintenance (65.2%), molding (49.6%), finishing (41.1%) and casting (41.0%) were the most common activities. Almost all workers (95.1%) cleaned the floors and machines with a brush or compressed air.This study demonstrates the importance of occupational factors in the genesis of COPD, especially among smelter workers. As with the fight against smoking-related disease, the removal or substitution of recognized hazardous agents is the best way of preventing the onset of COPD. This is why it is essential to continue research on its occupational risk factors

Que nous apprend la cohorte SAFEs sur l'adaptation des filières de soins intra-hospitalières à la prise en charge des patients âgés?

The ageing of the french population confronts our society with enormous challenges of which the adaptation and the organization of health and psychosocial cares to aged people. The SAFEs cohort analysis has led to better identify older inpatients that presented adverse outcomes during their hospitalization or after their hospital discharge. From the main results, a feature discussion concerning care models adaptation is proposed. This feature discussion highlights: the importance to rehabilitate functional disorders as soon as possible from the admission in the hospital environment; the negative impact playing by a fragmented and sometimes "over"-specialized hospital care system; the importance of the coordination in cares within and between hospital- and community-care models; the necessity for health care professionals to be better trained to geriatric medicine specificities. Therefore, with the double objective of both optimizing the use of the financial resources and to implement adapted and good quality cares, it is necessary to elaborate a real and concrete health policy specifically dedicated to co-morbid and disabled old adults. Such health policy will have to target the care networks as a whole and lead to specific and adequate financing assistances

Potentially inappropriate prescribing including under-use amongst older patients with cognitive or psychiatric co-morbidities

OBJECTIVE: the study aimed to determine the prevalence of and risk factors for inappropriate prescribing (IP) and prescribing omission (PO) in elderly with mental co-morbidities. PARTICIPANTS: One hundred fifty consecutive inpatients with mental co-morbidities hospitalised for acute medical illness (mean age 80 +/- 9, 70% of women) were considered for the study. MEASUREMENTS: IP and PO were prospectively identified according to STOPP/START criteria at hospital admission. RESULTS: over 95% were taking ≥ 1 medication (median = 7) which amounted to 1,137 prescriptions. The prevalence of IP was 77% and PO was 65%. The most frequent encountered IP concerned drugs adversely affecting fallers (25%) and antiaggregants therapy without atherosclerosis (14%). PO concerned antidepressants with moderate/severe depression (20%) and calcium-vitamin D supplementation (18%). Independent predictors for IP were increased number of concomitant drugs (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.13-1.89), being cognitively impaired (OR 1.83, 95% CI 1.55-2.24), and having fallen in the preceding 3 months (OR 2.03, 95% CI 1.52-2.61) or hospitalised in the preceding year (OR 1.09, 95% CI 1.02-1.23). Concerning PO, psychiatric disorder (OR 1.64, 95% CI 1.42-2.01) and increase level of co-morbidities (OR 1.79, 95% CI 1.48-1.99) were identified. Living in an institutional setting was a predictive maker for both IP (OR 1.45, 95% CI 1.27-1.74) and PO (OR 1.67, 95% CI 1.32-1.91). CONCLUSION: IP and PO were highly prevalent raising the need of a greater health literacy concerning geriatric conditions in non-geriatrician practitioners who care elderly as well as in the community, in hospital and institutional settings for improving quality and safety in prescribing medication