A qualitative study of adolescents with medically unexplained symptoms and their parents

Il est fréquent en médecine de premier recours de rencontrer des adolescents exprimant des symptômes somatiques pour lesquels aucune des investigations entreprises n'a permis de rendre compte d'une pathologie organique. De tels symptômes sont retrouvés dans la littérature sous la terminologie de symptômes médicalement inexpliqués (MUS) ou des troubles fonctionnels. Bien que la prévalence des adolescents souffrant de MUS est fréquente, les médecins éprouvent encore beaucoup de difficultés à prendre en charge et communiquer avec ces patients, principalement en raison d'une incompréhension de leurs besoins et préoccupations tant dans leur vie quotidienne que lors d'une consultation au cabinet. Le but de notre étude est de comprendre les expériences et vécus des adolescents avec des MUS ainsi que de leurs parents afin d'aider le praticien dans la compréhension de son patient dans sa globalité et ainsi d'améliorer sa prise en charge. Dans le premier article présenté, nous nous sommes intéressés à la vie quotidienne de ces adolescents en étudiant leurs relations avec leur famille et leur entourage ainsi que les répercussions sur leurs parcours scolaire et leurs activités extrascolaires. Dans le second article nous nous sommes penchés sur les relations qu'entretiennent ces adolescents et leurs parents avec le système de santé. Nous avons collecté des données qualitatives en moyennant des groupes focus incluant 16 adolescents atteints de troubles fonctionnels et leurs parents. L'analyse a permis de faire émerger les difficultés que ces jeunes et leurs familles vivent au quotidien et comment ils sont confrontés à la solitude dû principalement à l'incompréhension sociale. Les résultats mettent aussi en évidence l'insatisfaction de ces jeunes et de leurs parents par rapport à la prise en charge médical, notamment en raison d'un manque de communication. -- Medically unexplained symptoms (MUS) are common among adolescents and are frequently encountered in primary care. Our aim was to explore how these adolescents and their parents experience the condition and its impact on their daily lives and to provide recommendations for health professionals. Using a qualitative approach, six focus groups and two individual interviews were conducted. These involved a total of ten adolescents with different types of MUS and sixteen parents. The respondents were recruited in a university hospital in Switzerland. A thematic analysis was conducted according to the Grounded Theory. The analysis of the data highlighted four core themes: disbelief, being different, concealing symptoms, and priority to adolescent's health. Transcending these themes was a core issue regarding the discrepancy between the strategies that adolescents and their parents use to cope with the symptoms. Health professionals should be made aware of the emotional needs of these patients and their families

Prévalence de la prise en charge ostéopathique chez les nourrissons de1,3et6mois

Objectif : l'objectif de cette étude est de déterminer le nombre d'enfant de 0 à 6 mois de la population vaudoise ayant eu recours à l'ostéopathie, de caractériser les motivations des parents à consulter un ostéopathe pour leur enfant, d'évaluer le niveau de satisfaction d'une telle prise en charge et d'établir un profil de parents type s'il en existe un. Méthode : La méthodologie utilisée dans cette recherche prospective s'est faite au moyen d'un questionnaire accessible aux parents des sujets d'étude en format papier ou en format numérique disponible en ligne sur internet. La distribution des questionnaires s'est faite par l'intermédiaire de pédiatres installés, de sages-femmes à domicile, de mamans de jour et s'est déroulée sur une période de 3 mois à la fin de l'année 2011. Résultats : 73.3% des sujets sondés disent avoir consulté au moins une fois un ostéopathe pour leur enfant. Dans une grande majorité des cas les causes du recours à l'ostéopathie sont, d'un point de vue strictement médical, des événements fréquents et relativement banaux dans les premiers mois de vie des enfants. Beaucoup de parents consultent un ostéopathe pour effectuer un contrôle « général » de leur enfant, souvent avant même le premier rendez-vous chez leur pédiatre. Ils sont en majorité satisfaits de la manipulation et envisagent de se rendre à nouveau chez ce praticien en cas de besoin ou pour un simple contrôle du développement de leur enfant. Il ressort de cette analyse trois profils de parents : les parents n'ayant pas recours à l'ostéopathe pour leur enfant, les parents ayant recours à cette thérapie occasionnellement et les parents y ayant recours fréquemment. Ces trois profils de parents se définissent uniquement sur l'usage ou non de l'ostéopathie pour l'enfant et de sa fréquence mais ils ne sont pas influencés par les ressources financières des parents et leur propre recours à l'ostéopathie. Conclusion : Cette étude a permis de constater que le nombre de parents ayant recours à l'ostéopathie pour leur nouveau-né est important, en effet 73,3% des sujets ont été manipulé par un ostéopathe au cours de leurs six premiers mois de vie. Le contrôle précoce du nourrisson chez un ostéopathe semble rassurer les parents sur la santé de leur enfant. L'ostéopathe s'impose ainsi comme un référent supplémentaire aux soins du nourrisson, au même titre que le pédiatre

Influence of addition order and contact time on thorium(IV) retention by hematite in the presence of humic acids

International audienceThe influence of addition order and contact time in the system hematite (alpha-Fe2O3)-humic acid (HA)-thorium(IV) (Th(IV)) was studied in batch experiments. Th(IV) is considered here as a chemical analogue of other actinides (IV). The sorption isotherms were acquired varying pH in the range 2-10 and HA concentration in the range 1-100 mg/L. As already observed by numerous authors, Th(IV) retention was hindered when HA and hematite were equilibrated beforehand during 24 h. As it has been observed in a previous study, this effect was drastic when the ratio between humic and surface (iron oxide) sites exceeds a critical value. However, when HA was added after a 24-h equilibration of the hematite-Th(IV) system, Th(IV) was barely desorbed from the iron oxide surface. Furthermore, no drastic effect of the ratio between humic and surface sites could be evidenced, as the increase of HA concentration only results in a slight monotonic decrease in Th(IV) retention. Increasing contact time between components of the systems only indicated slight Th(IV) retention variation. This was interpreted as a consequence of slow kinetic controls of both the Th(IV)-HA complexation and HA-hematite sorption

Variability of potato petiole nitrogen in response to nitrogen fertilizer, implications for variable management

Non-Peer ReviewedRecent increases in the cost of fertilizer nitrogen have prompted producers to assess the potential to vary inputs in space and time to produce the highest marketable yield of potatoes. A study was conducted from 2005 to 2007 near Brandon, Manitoba Canada, to assess the spatial variability of potato yield in upper, middle and lower landforms on a sandy loam soil in response to a range of nitrogen fertilizer rates and split application. Petiole nitrogen, determined late in the growing season, was correlated with potato yield and was used to assess nitrogen sufficiency through the growing season. Petiole nitrogen varied with time during the growing season, from uniform levels in June across all fertilizer treatments, to those which varied with fertilizer treatment in July and August. Furthermore potato petiole nitrogen was higher in lower landforms during July and August, where higher total and marketable yields were recorded. The potential for split application of nitrogen in potatoes based on management zones or sensor readings will have to be carefully assessed to account for temporal and spatial variability

Prospects for annihilating dark matter in the inner galactic halo by the Cherenkov Telescope Array

We compute the sensitivity to dark matter annihilations for the forthcoming large Cherenkov Telescope Array (CTA) in several primary channels and over a range of dark matter masses from 50 GeV up to 80 TeV. For all channels, we include inverse Compton scattering of e± by dark matter annihilations on the ambient photon background, which yields substantial contributions to the overall γ-ray flux. We improve the analysis over previous work by: (i) implementing a spectral and morphological analysis of the γ-ray emission; (ii) taking into account the most up-to-date cosmic ray background obtained from a full CTA Monte Carlo simulation and a description of the diffuse astrophysical emission; and (iii) including the systematic uncertainties in the rich observational CTA data sets. We find that our spectral and morphological analysis improves the CTA sensitivity by roughly a factor 2. For the hadronic channels, CTA will be able to probe thermal dark matter candidates over a broad range of masses if the systematic uncertainties in the data sets will be controlled better than the percent level. For the leptonic modes, the CTA sensitivity will be well below the thermal value of the annihilation cross-section. In this case, even with larger systematics, thermal dark matter candidates up to masses of a few TeV will be easily studied

On the study of Th(IV)-humic acid interactions by competition sorption studies with silica and determination of global interaction constants

http://www.radiochimacta.deInternational audienceThe influence of humic acids (HA) on the retention of thorium (IV) onto the surface of silica colloids is investigated. Thorium is considered as an analogue of tetravalent actinides (U, Np, Pu), except for the fact that it has no f electrons. Silica (SiO2) is chosen as a model surface because it is a component of many minerals and because of its weak HA sorption properties. Retention experiments are performed by batch procedure at constant ionic strength (I = 0.1M NaClO4), at various pH (2 to 9) and HA concentrations (1–100 mg/L). The sorption of Th(IV) onto colloidal amorphous silica is characterised using a surface complexation model. The ternary system (i.e. HA-Th-Silica) clearly shows the influence of HA on Th(IV) retention. This can lead to a strong reduction of the amount of Th(IV) sorbed onto silica in the presence of HA compared to silica colloids without HA, due to a predominant part of thorium present in solution as humic complexes. In a pH range where no organic coating onto silica occurs, there is a competitive reaction between Th(IV) sorption onto the silica surface and onto HA reactive functional groups. In this case, Schubert's method is applied to obtain a global interaction constant for the Th(IV)-HA system. The large interaction constant values indicate a strong affinity of HA for Th(IV)

The Link Between Cannabis Use and Violent Behavior in the Early Phase of Psychosis: The Potential Role of Impulsivity.

Recently, the literature has shown that Cannabis Use (CU) was a risk factor for Violent Behavior (VB) in patients with psychosis, and those in the early phase of psychosis (EPP). These findings are relevant because of the high prevalence of CU in this EPP, and the potential for prevention during this phase of illness. However, there is still a lack of clear explanations, supported by empirical evidence, about what underlies the link between CU and VB against other. This viewpoint reviews the scientific literature on the link between CU and VB, and the involvement of impulsivity in this relationship. This last point will be addressed at clinical and neurobiological levels. Recent studies confirmed that CU is particularly high in the EPP, and is a risk factor for VB in the EPP and schizophrenia. Studies have also shown that impulsivity is a risk factor for VB in psychosis, is associated with CU, and may mediate the link between CU and VB. Research suggests a neurobiological mechanism, as CU affects the structures and function of frontal areas, known to play a role in impulsive behavior. Scientific evidence support the hypothesis of an involvement of impulsivity as a variable that could mediate the link between CU and aggression, particularly, when CU has an early onset. However, this hypothesis should be confirmed with longitudinal studies and by taking into account confounding factors. The studies highlight the relevance of early prevention in the EPP, in addition to interventions focusing on psychotic disorders

Failure analysis of a steel motorcycle kickstand

Copyright @ 2009 Springer US.A fractured steel motorcycle kickstand was metallurgically investigated using a range of failure analysis tools [visual examination, energy dispersive X-ray (EDX) analysis, electron microprobe analysis (EPMA), scanning electron microscopy (SEM), fractography, optical microscopy, hardness testing and non-destructive testing (NDT)]. The steel kickstand’s composition, its microstructure, electron fractographs, and mechanical test results have been critically interpreted. Some evidence of wear damage, in the failed kickstand, was observed. The microstructural and fractographic analyses showed pre-existing micro-cracks which were believed to have grown to result in ductile failure followed by acceleration of corrosion. Recommendations have been made to avoid the failure of the motorcycle kickstand

Factors associated with repetitive violent behavior of psychiatric inpatients.

A small number of psychiatric inpatients displays a large proportion of Violent Behaviors (VB). These can have a major impact on both victims and patients themselves. This study explored personal, situational and institutional risk factors and their combined effects, which could lead to repetitive VB (three or more assaults). Data from 4518 patients, aged 18 to 65, admitted to an acute psychiatric care facility, were included in the analysis. VB, defined as physical aggressions against another person, were assessed by the Staff Observation Aggression Scale-Revised. 414 VB were reported during the study period, involving 199 patients. 0.75 % of all patients were repetitively violent and committed 43% of all VB. Factors that were linked to repetitive VB were living in sheltered housing before hospitalization, suffering from schizophrenia with substance abuse comorbidity, cumulating hospitalization days and some situational factors, like the fact of being in nursing offices and pharmacies. When all personal, situational and institutional factors were considered together, the combined effects of length of stay and living in sheltered housing increased the risk of repetitive VB. We have identified a small group of vulnerable patients for whom new modalities of inter-institutional networking should be developed to prevent repetitive VB