[Discrimination perceived by people with a diagnosis of schizophrenic disorders. INternational study of DIscrimination and stiGma Outcomes (INDIGO): French results]. / La discrimination vécue par les personnes ayant reçu un diagnostic de troubles schizophréniques. Premiers résultats français de l'étude INDIGO.

INTRODUCTION: The INDIGO study (INternational study of DIscrimination and stiGma Outcomes) aims at assessing the impact of schizophrenic disorders diagnosis on privacy, social and professional life, in terms of discrimination. In the general population, and even among health and social professionals, erroneous negative stereotypes (double personality, dangerosity) lead to high social distance. And this has an impact on various parts of daily life: employment, housing, compliance, self-esteem… About a tenth of the adult population suffers from mental disorders at any one time. These disorders now account for about 12% of the global impact of disability, and this will rise to 15% by the year 2020. People living with schizophrenia, for example, experience reduced social participation, whilst public images of mental illness and social reactions add a dimension of suffering, which has been described as a "second illness". Stigmatizing attitudes and discriminatory behavior among the general population against people with severe mental illness are common in all countries. Globally, little is known of effective interventions against stigma. It is clear that the negative effects of stigma can act as formidable barriers to active recovery. METHODOLOGY: The INDIGO study intends to establish detailed international data on how stigma and discrimination affect the lives of people with a diagnosis of schizophrenia. The first aim of the INDIGO study is to conduct qualitative and quantitative interviews with 25 people with a diagnosis of schizophrenia in each participating site, to elicit information on how the condition affects their everyday lives, with a focus upon sites in Europe. The second is to gather data for all participating countries on the laws, policies and regulations which set a clear distinction between people with a diagnosis of mental illness and others, to establish an international profile of such discrimination. A new scale (Discrimination and Stigma Scale [DISC]), used in a face-to-face setting was developed. Interviewers asked service users to comment on how far their mental disorder has affected key areas of their lives, including work, marriage and partnerships, housing, leisure, and religious activities. For country-level information, staff at each national site gathered the best available data on whether special legal, policy or administrative arrangements are made for people with a diagnosis of mental illness. These items included, for example, information on access to insurance, financial services, driving licenses, voting, jury service, or travel visas. The INDIGO study is conducted within the framework of the WPA global program to fight stigma and discrimination because of schizophrenia. French interviews occurred in two sites (Lille and Nice) on a sample of 25 patients. RESULTS: First, expressed disadvantages are high for several items (all relations, work and training, housing). In addition, we wish to highlight three specific points: almost half of the participants (46%) suffer from not being respected because of contacts with services, 88% of them felt rejected by people who know their diagnosis, and 76% hide/conceal their diagnosis. Positive experienced discrimination was rare. Two thirds of participants anticipated discrimination for job seeking and close personal relationships, sometimes with no experienced discrimination. CONCLUSIONS: This study, one of the rare in France adopting the point of view of a stigmatized group, revealed the numerous impacts of a diagnosis of schizophrenic disorders on everyday life. Comparisons between French and international results confirmed that the situation is not different in France, and even highlighted the extent of the stigmatization in the country.

[The incidence of the child psychic handicap in the department of Var in 2001 from CDES files]. / L'incidence du handicap psychique chez l'enfant dans le Var en 2001 à partir des dossiers de la CDES.

BACKGROUND: Thanks to an automated treatment of the medical information of the Departmental Commission of the Special Education in the Var, set up since 1999, under the responsibility of an epidemiologist doctor, it is possible to measure the incidence rates of the children recognized as been handicapped. METHODS: This study is the first one performed on the basis of good-quality and reliable medical and administrative informations. Moreover, this study has yielded thinking on the criteria of handicap definition and nomenclature to be used to define psychic deficiency. RESULTS: The occurrence rate of children recognized as handicapped by the Departmental Commission of the Var is 2.04%. The rate of children with a psychic deficiency recognized by the Commission is 1.25%. These rates are 2.5 times higher among boys than girls. Psychic deficiencies occurs mainly between five and nine years of age, at the entry to the primary school. The western part of the department displays rates of nevrotic, reactional, instrumental functions, and training disorders that are higher than those of the other geographical areas. For the eastern part of the department, the rates of psychoses, pathologies of the personality and evolutionary disorders are the highest. The distribution of declared pathologies probably reflects equipment of the medical sector of childpsychiatry and distribution of the liberal assumptions of responsibility. The geographical area of Draguignan is significantly under-equipped with medico-social structures but is characterized by a high rate of children with a psychic handicap. CONCLUSION: The Law of February 11 2005 for chance and equal right, stipulates a counting of the people affected by handicap and the underlying pathologies, to define the ethiology of the handicap, to improve the accompaniment of those people and to develop actions aimed at reducing the incapacities and at the prevention of risks. It is within the Departmental houses of the handicapped person that the information systems will have to collect a minimum common set of standardized data to meet requirements of the Law of February 2005 and to take part in the planification of the means of medico-social establishment.

[The medical profile of children for whom a medico-social institution is recommended by the Departmental Commission of Special Education in Var]. / Profil médical des enfants orientés par la Commission Départementale de l'Education Spéciale du var vers des structures médico-sociales.

Since September 1999, the Commission of Special Education (CDES) in the French department of Var implemented a computer system to electronically handle medical records and information in conformance with the circular of November 5, 1998. The study presented here is based upon the first 247 orientation requests entered in the academic year 1998-1999. Six groups of children were categorised according to the main diagnostic clusters: psychosis, non-psychotic personality disorders and behavioural disorders, mental deficiency and chromosomal anomalies, instrumental malfunctioning and learning problems, central neurological problems, and motor and sensory difficulties. This study describes the medical diseases and handicaps of children for whom a medico-social assistance has been requested for the first time at the CDES based upon the recommended orientations. The revision of database management system foreseen by the implementation of the OPALES programme (Guide to Management and Administration of local Special Education) will integrate the medical, social and administrative parameters, and it will allow for the provision of a more streamlined analysis of and response to the problems and issues of handicapped children which are addressed to the CDES. The system will constitute a sustainable database on the handicaps of the children throughout the entire department.

Testing the proportional hazards assumption in medical survival studies--application to a population-based study of acute myeloid leukaemia.

BACKGROUND: In the analysis of survival data using the Cox proportional hazard model, it is assumed that the magnitude of mortality risk for a predictor variable remains proportional over time. The time-dependent linear model and the piece-wise proportional hazard model (two or four intervals) take into account the variation of the risk over the entire follow-up period. METHOD: The three existing models were applied to a series of 266 patients with acute myeloid leukaemia (AML), diagnosed between 1980 and 1992 and recorded by the Registry of Hematopoietic Neoplasms in Côte d'Or, France. RESULTS: A non-proportional effect of age, period of diagnosis, whether the illness was primary or secondary and French-American-British (FAB) subtype was found significant. In particular, the effect of M2 versus M4-M5 subtypes was revealed by the non-proportional analyses, although this effect was non-significant using the Cox model. CONCLUSIONS: The clinical explanation of the variation of these effects over time is discussed, for example, relating the increase over time of the positive effect of the period of diagnosis to therapeutic improvements. Confirmation of these results on an independent data set is required.