L'hopital et les familles affectees par le VIH: Mettre les larmes en mots

This paper broaches the difficulties met in the medico-psycho-social care of the families affected with the human immunodeficiency virus, in which the parents and at least one of the children are infected or ill. The HIV infection, and more specifically the impact of the secret it implies, disturbs the intra-familial relationships, complicates the setting of the socio-familial links and shuts the children in an indefinable loneliness. This context has an impact on the psychological and hospital treating procedures: the main vectors and pitfalls are specified for each one of them. Finally, the 'psy' function within the team is broached.SCOPUS: re.jinfo:eu-repo/semantics/publishe

A PROPOS DE L'INSOMNIE PRIMAIRE DU NOURRISSON

After recalling the clinical picture of the infant's primary insomnia and evoking the behavioural approaches usually utilized in paediatric practice, we distinguish two psychopathological configurations. In the first one, insomnia appears as proceeding from a mutual adaptation difficulty between the parents and the baby. It is often favoured by particular circumstances around pregnancy and birth which focus the parental projections on the baby. These cases are generally solved after brief psychotherapeutic interventions. In the second configuration insomnia is set in a severe family dysfunctioning, underlied by parental psychopathologies in which the separation problematic weakens the narcissistic foundations. The treatment implies a long and difficult family approach, permitting to set up progressively the conditions of an individuation of the baby and, through him, of his parents.SCOPUS: sh.jinfo:eu-repo/semantics/publishe

Parentalité et troubles du comportement en clinique de la petite enfance: Une approche familiale

In a short theoretical introduction from a developmental point of view, we describe the dynamics of the first phase of child individuation. We refer to the notions of disillusionment, object use and the capacity for solicitude as well as their possible impasses. In reference to the contributions of the School of Geneva, we insist furthermore on the predominance of pathological projective identification in the infant/parent relationship. These notions seem extremely useful to us in order to understand and describe our clinical work with families. Having analysed the unconscious dimension which exists in infant/parent interactions and the meaning of a symptom in family dynamics, we distinguish, without pretending to be exhaustive, between four psychopathological configurations - which obviously can be interrelated in clinical practice. We conclude with some considerations regarding our therapeutic setting and the levels at which our interventions take place.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Du diagnostic anténatal à la néonatologie, le choix des soins palliatifs : une lecture à deux voix

The diagnosis of an incurable fetal abnormality creates an important psychological trauma for the parents. In this particular context, the issue of current multidisciplinary perinatal medicine is to foster real parental bonds. Unlike the difficult choice to terminate the pregnancy for medical reasons, palliative perinatal care supports parenting into a life project even if it is very brief. Establishing a palliative care project before the birth of the child contributes to accept the prognosis, to support parents in their full-fledged roles, to share the responsibility of the decision with caregivers and relatives and to care for the newborn and his family. Nevertheless, from the prenatal diagnosis to the development of neonatal palliative care, the process can be fraught with difficulties: inconsistency of speech between interdisciplinary teams, or between antenatal and postnatal management, diagnostic and prognostic uncertainties, the fragility of the alliance with the parents, the choice of words, unspoken words, projection of health care teams, breach of a temporality needed for all stakeholders, etc. In this article we propose an analysis of these situations and consider solutions.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Le soignant, tiers dans la construction du lien parent - Bébé prématuré hospitalisé

Discussions with nurses and parents of preterm babies hospitalised in a neonatal intensive care unit points the interdependence of relationships inside the triad parents-babycaregiver and the caregiver's impact on parental process. It shows the positive impact of the caregiver on the parents-baby 'early relationships, but also the vulnerability of interactions inside the triad and the possibility of emergence of negative interactive buckles. By leading the caregivers to elaborate their perception of their function, of the parents' function and the interactions inside the triad parents-baby-caregiver, we could contribute to the positive evolution of this triad and improve the meeting between the parents and their child.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Apport et richesse de l'échelle de Brazelton dans l'observation des nourrissons nés prématurément

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Place of the child psychiatrist in the handling of HIV + families

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Global Surface Water Product Reliability for Amazon Floodplain Hydrology

International audienceFreshwater wetlands ensure fundamental functions such as flood mitigation,groundwater recharge, water purification, and nutrient and sediment retention, as well assupporting high levels of biodiversity. Amazonian floodplains support one of Earth´s largestreservoirs of biodiversity, yet are increasingly threatened by land cover and land use changesinduced by large-scale agriculture expansion, waterway network development, andhydroelectric dam construction. These pressures conjointly with climate change may havedramatic impacts on floodplain biodiversity and endemic plant and animal species. Becauseflooding dynamics is an important driver of floodplain biodiversity and productivity,characterizing and monitoring floodplain hydrology are important to supporting biodiversityconservation. Several global- or regional-scale wetland or flood extent maps have beenproduced. Until recently, these maps were of coarse spatial resolution, inadequate to supportwetlands biodiversity conservation. Recently, based on Landsat imagery, Pekel et al. (2016)produced a global surface water (GSW) map at 30 m and analyzed changes inminimum/maximum flood extent and flood duration over the past three decades. However, intropical regions, clouds and vegetation may significantly impact the accuracy of surface watermapping based on optical data. On the other hand, SAR sensors acquire data regardless ofweather conditions and SAR imagery has been widely used over the past decades to monitorand map wetland inundation and vegetation worldwide, including in the Amazon region.In this study, we use Sentinel-1 Synthetic Aperture Radar (SAR) time series (12-dayrepeat cycle at this latitude, 10 m resolution) to monitor the flood dynamics of a segment ofthe Solimões/Amazon river encompassing the Curuai floodplain (eastward) and the Janauacáfloodplain (westward) for the year 2017 (covering 6 S1 tiles). The Curuai floodplain (4000km2, including the local watershed) forms a vast complex system of temporally connectedlakes, flooded forest and fringing wetlands along the Amazon river right margin. Severalperennial or intermittent channels of various size link the floodplain lakes system with theAmazon River. The Janauacá floodplain is a medium size system (786 km2, including thelocal watershed), composed by a lake and associated flooded forest and other wetlands, linkedto the Solimões River by a single channel.Images from the S1 time series were stacked (around 30 images per tile), a meanimage was calculated and a thresholding classification was applied on the basis of optical data(Sentinel 2). In this mean classification, areas always flooded will appear in black, areas neverflooded in light grey and areas occasionally flooded in shades of grey on flood duration. Foreach date of the stack, the same thresholding classification is performed and compared to themean classification in order to produce 4 land cover classes: open water, potentially floodedvegetation, low vegetation and forest. Classification results are then refined applying posttreatments: we used the HAND index combined with spatial and temporal rules to avoidoverestimation of water in areas that are not compatible with the hydrodynamics of the area.We compare our results with the GSW products in terms of maximum water extent andinundation duration in order to assess the reliability of GSW for large Amazonian floodplains.Maximum open water extentBoth studies are in good agreement, with an estimated open water maximal extent of27 000 km2 (our study) and 30 000 km2 (Pekel et al., 2016). Most of the discrepancies areobserved along floodplain and mainstream margins, and differences are greater at Curuai thanat Janauacá. The lengths of the time series used to construct our product and GSW productsare very different. Pekel et al. (2016) used a Landsat chronology over the 32 last years, whilewe used only the year 2017. Consequently, the maximum water level recorded at Óbidosgauge for our study was 760 cm while it was 860 cm over the last 32 years included in Pekelet al.’s study. As reported in Sippel et al. (1998), flood extent and main stream water level aredirectly related. According to their relationship between water level and flood extent, a 1 mwater level variation induces an increase of roughly 11% of the flood extent, comparable withthe expected flood extent increase for the same water level variation in the Curuai floodplain(Bonnet et al, 2008). Applying this percentage to our results leads to a maximal flood extentof circa 30 000 km2, similar to the extension found by Pekel et al. (2016).Flood durationDiscrepancies between the GSW and Sentinel-based products are larger in the case offlood duration. These differences are not related to upstream or downstream position but tolateral flow propagation across the floodplain. Throughout the entire study area, strongheterogeneities are observed with variations between both results of several months.At the level of the floodplains, we evidence smaller water residence duration in themain lake of the Janauacá floodplain (between 0 and 2 months). In Curuai, we observe longerwater residence duration throughout the floodplain (up to 8 months). Part of the discrepanciesmight be explained by water level differences between the time series used to build theproduct (2014-2015 for GSW vs 2017 in this study). Thanks to the repetitivity of cloud-freeSentinel 1, we provide a finer quantification of the temporal dynamics of floods in thefloodplains and explain the over-estimation and under-estimation of flood duration inJanauacá and Curuai respectively by the GSW product. Therefore, compared with the GSWproduct, the flood duration dynamics of our product correspond more closely withhydrodynamic modelling results obtained by Bonnet et al. (2017) for the Janauacá floodplainand Rudorff et al. (2014) and Bonnet et al. (2008) for the Curuai floodplain.We conclude that GSW provides realistic maximum open water extents even at localscale and with accuracies suitable for supporting hydrologic applications, for example modelcalibration or validation. On the other hand, GSW should be used cautiously when looking atflood duration and subsequent hydrological connectivity analysis, which are fundamentalproperties to support biodiversity conservation. The Sentinel 1 and Sentinel 2 constellationshould provide improved mapping of flood duration at global scale

Les mesures de décontamination individuelles divisent par deux le risque d'infection du site opératoire après chirurgie du rachis

International audienceIntroduction: L'incidence des infections du site opératoire (ISO) après chirurgie rachidienne est estimée entre 1 et 10 %. Ces évènements sont responsables d'une augmentation de la morbidité, de la mortalité et des coûts de prise en charge. La décontamination du portage du Staphylococcus aureus (S. aureus) a déjà montré son efficacité dans la prévention d'infection du site opératoire dans de nombreuses disciplines chirurgicales. L'objectif de cette étude était d’évaluer l'intérêt de stratégie de prévention des ISO, et en particulier la décolonisation du portage nasal du SA part un protocole d'application de mupirocine. Matériel et méthodes: Nous avons conduit une étude opérationnelle bicentrique, permettant d’évaluer 5314 patients après chirurgie rachidienne au cours d'une période de sept ans. Dans les deux centres nous avons comparé des périodes avant et après implantation de deux mesures: la modification de l'antibioprophylaxie et la décolonisation du portage du SA. L'homogénéité des différents échantillons de patient a été évaluée par le recueil de caractéristiques chirurgicales et individuelles. L'efficacité a été évaluée par la mesure mensuelle de l'incidence des ISO, permettant de mesurer son évolution après l'implantation de mesures. Résultats: L'incidence des ISO était divisée par 2, de 7,3 % à 3 % à l'hôpital Beaujon est de 8,3 % à 3,9 % à l'hôpital européen Georges Pompidou (HEGP). Nous n'avons observé aucune diminution significative du taux de SA à dans la par désinfection du site opératoire après implantation de mesures. Conclusions: Les mesures de décolonisation du portage du SA doivent être recommandées après chirurgie rachidienne. Elles doivent être intégrées à une réflexion globale d'amélioration de la prise en charge des patients opérés pour améliorer la prévention des infections du site opératoire

Individual decontamination measures reduce by two the incidence of surgical site infections in spinal surgery

International audienceBackground: In spinal surgery, incidence of surgical site infections (SSI) is estimated between 1 and 10%. It results in increased morbidity, mortality and cost of management. Individual Staphylococcus aureus (SA) decolonization has already proved efficiency to prevent those events in various surgical domains. The aim of this study was to evaluate a strategy of prevention of SSI and in particular the decolonization of the nasal carriage of SA by a protocol with Mupirocin application. Methods: We conducted a bicentric observational study on 5314 spinal surgery patients over a seven-year period. In both center, we compared periods before and after implementation of two measures: modification of antibioprophylaxis and staphylococcus decolonization. Homogeneity of the different samples of patients was assessed through measure of individual and surgical variables. We measured monthly incidence of SSI and evaluated its evolution in order to assess efficiency of these interventions. Results: The incidence of SSI decreased by half, from 7.3% to 3% at the Beaujon Hospital and from 8.3% to 3.9% at the Georges-Pompidou European Hospital (GPEH). We do not observe any significant decrease of SA rate in these SSI. Conclusion: We believe that Staphylococcus aureus decolonization should be recommended in spinal surgery, and should be combined with an overall improvement of the quality of care