Determinants of total incapacity to work duration among 231 victims of school violence in France.

INTRODUCTION: This study aimed to identify the factors that may influence the duration of the total incapacity to work (TIW) among victims of school violence from the perspective of clinical forensics practice. METHODS: It used a cross-sectional design to collect data from school violence victims examined at a French forensic unit following a judicial requisition. Logistic regression models were used to identify whether the victim's characteristics, the circumstances of the violence, or the evaluation itself could predict a TIW duration equal to or greater than 2 days. RESULTS: Among 231 victims of school violence, the presence of traumatic injuries such as sprains or broken bones (OR=19.8; 95% CI, 1.7-23.4, p = 0.018), bruises (OR=6.3; 95% CI, 1.5-26.8, p = 0.007), and muscle contractures (OR=7.3; 95% CI, 2.0-26.2, p = 0.007) were the main risk determinants for a longer TIW. Factors with a mild impact were the presence of ecchymosis (OR=3.8; 95% CI, 1.4-9.9, p = 0.007), anxiety (OR=3.4, 95% CI, 1.6-7.1, p = 0.001), female physician (OR=2.5, 95% CI, 1.2-5.1, p = 0.016), and the presence of a psychological follow-up for the victim or the need for a psychological consultation (OR=3.6, 95% CI, 1.2-10.7 and OR=4.7, 95% CI, 1.9-11.5, p = 0.001). CONCLUSION: These results highlight the importance of developing a more uniform model in determining TIW, whatever the physician's characteristics, through screening and reporting methods for both physical and psychological symptoms.

[Early satisfaction with care among outpatients with substance dependence]. / Satisfaction précoce vis-à-vis des soins ambulatoires chez des patients dépendants aux substances psychoactives.

BACKGROUND: Patient satisfaction with health care is an important indicator of health care quality. The main objective was to identify factors associated with early outpatient satisfaction with care 45 days after study inclusion for alcohol and opioid dependence. The secondary objective was to study the reproducibility of the satisfaction during the care. METHODS: A longitudinal study was conducted. Satisfaction was assessed during the early care process 15 and 45 days after study inclusion using the quality of care satisfaction questionnaire in outpatient consultation EQS-C. Multiple linear regression was performed to identify the variables associated with satisfaction level. The reproducibility of the questionnaire between the two measurements (15 and 45 days after inclusion) was tested by intraclass correlation coefficient. RESULTS: A total of 189 outpatients were included, and 90 patients completed the satisfaction questionnaire both at 15 and 45 days after inclusion. The level of early satisfaction with care was high. If patients without a history of previous care for substance dependence were at first more satisfied at 45 days (ß=6.8; P=0.05) than those who had received care previously, only the total score of the satisfaction with care at 15 days is associated with satisfaction with care at 45 days when taken into account in the model (ß=0,7; P<0.0001). The results indicated good total satisfaction reproducibility with an intraclass correlation coefficient ICC=0.68. CONCLUSION: We recommend an early measure of satisfaction with care among outpatients with substance dependence.

[Socio-demographic and clinical characteristics of adolescents hospitalized in French units for inmates: Results of a cross-sectional study]. / Caractéristiques socio-démographiques et cliniques des adolescents détenus hospitalisés en unité hospitalière spécialement aménagée : résultats d'une étude transversale nationale.

BACKGROUND: In France, on the first of January 2018, 772 underage persons were in jail or about 1.1 % of the incarcerated population. The prevalence of psychiatric disorders among those inmates is high. As a result psychiatric care (and particularly full-time hospitalization) is essential for this population. The unités hospitalières spécialement aménagées (UHSA) are full-time inpatient hospitalization units for inmates in France. Adults but also underage inmates can be admitted to UHSA for voluntary or involuntary hospitalization. However, no study about the characteristics of young patients admitted to UHSA is currently available. The aim of this study is to describe the population of children and adolescent patients hospitalized in these facilities and to evaluate the care provided. METHOD: We conducted a retrospective study, including all the patients under 18 years of age, who have been hospitalized in UHSA since its creation in 2010 until 31 December 2016. Anonymized data concerning socio-demographic profile, clinical symptoms and care provided have been collected from the medical records of each patient. RESULTS: Overall 80 underage patients were included, for 120 hospitalisations in UHSA. Those patients are mainly male (80%) with a mean age of 16.7 years. They are mostly hospitalized with their consent (59%) for stays of about 50 days and frequently after self-harm behaviours. The main diagnoses are anxiety disorders (26%) and psychotic disorders (25%). At the end, 86% of the patients are prescribed a psychotropic drug treatment and 40% of those medical drugs are prescribed outside the guidelines. Finally, several specific problems were identified. Especially, contact with families and educators or access to education programs are very challenging. CONCLUSION: This study highlights the current difficulties encountered in the management of inmate underage patients in full-time psychiatric hospitalization. In this paper, we propose areas for improvement through (1) specific arrangements to receive young patients (specific service's management in order to reinforce the observation of those young people, to facilitate contact with their families, to improve the access to education programs, etc.); (2) specific arrangements in the treatment offered to young patients in UHSA (specific training course for nurses, specific therapeutic programs, etc.); (3) the development of networks working with psychiatric services inside and outside the prison, educators, families and prison services, in order to promote the continuity of cares.

Pitfalls in the diagnosis of new-onset frontal lobe seizures.

We reported the case of a young woman who received an antiepileptic drug after a first possible generalized tonic-clonic seizure with no clear inter-ictal epileptic paroxysms in the routine electroencephalogram. Her stereotypical movements decreased but did not disappear with treatment. Then a diagnosis of PNES was considered by neurologist after witnessing a stereotypical motor episode. While AED treatment was decreased and stopped, epileptic seizure frequency and severity increased with secondary generalized tonic-clonic seizures. Then she presented postictal psychotic features that combined with video-EEG findings led to the final diagnosis of new onset pre-frontal lobe epilepsy.