A Clinically Significant Difference on the COPM: A Review.

Background. The Canadian Occupational Performance Measure (COPM) assists occupational therapists to identify occupational performance problems using a client-centred approach. Since its first publication in 1991, there has been abundant evidence of the ability of the COPM to detect a statistically significant difference as an outcome measure. There has also been a tacit understanding that a difference of 2 points from pre-test to post-test on either Performance or Satisfaction COPM score represents a clinically significant difference. There is however, some confusion about the origins of this claim. Purpose. To ascertain empirical evidence for the claim that a clinically significant difference is a change score ≥2 points. Method. We conducted a scoping review of peer-reviewed literature (1991-2020) for intervention studies using the COPM as an outcome measure and examined intervention type and change scores. Findings. One hundred studies were identified. The COPM was used to assess effectiveness of eight types of occupational therapy interventions. The common belief, however, was not empirically supported that clinical significance can be asserted on the basis of a two-point change in COPM scores. Implications. Further research is needed to test alternative approaches to asserting clinical significance or a minimal clinically important difference.

French Red Cross Volunteer Rescue Workers: Psychological Characteristics and Healthcare Support After the January 2015 Terrorist Attacks in Paris.

Few studies have explored the psychological consequences of terrorism on volunteer rescuers. We examined the psychological characteristics of volunteer rescuers after the January 2015 terrorist attacks in France. We analyzed the results of the IMPACTS study regarding the somatic, psychological, and social characteristics of the French Red Cross volunteer rescuers who intervened during these terrorist attacks. We used a standardized questionnaire during a face-to-face interview, 6 to 9 months after the attacks. Forty-one volunteers were included. Nine were presenting anxiety disorders, 11 were displaying recurrent depressive episodes, and five were displaying abusive alcohol consumption. Twenty-seven were provided with a debriefing after their intervention. Half of the most exposed volunteers had no contact with mental health professional 9 months after their intervention. A healthcare protocol, covering short-, medium-, and long-term care, should be systematically proposed to volunteer rescue workers to minimize the risk of chronic psychic posttraumatic disorders.

Multiple brief interventions in police custody: The MuBIC randomized controlled study for primary prevention in police custody. Protocol and preliminary results of a feasibility study in the Paris metropolitan area, France.

BACKGROUND: The 15- to 35-year-old population has little contact with the health care system and is exposed to risk factors. Several studies demonstrated the feasibility of brief interventions (BIs) in different settings, e.g., in addiction medicine during police custody, where arrestees are entitled to a medical examination. Approximately 700,000 individuals are detained in police custody in France annually, and custody is an opportunity for young people to be medically examined. The characteristics of the detainees and previous experience with BIs suggest that custody is an opportunity to contribute to primary prevention. We propose to investigate the feasibility of such a contribution. OBJECTIVES: The aim of this article is to present a study protocol and some preliminary results. The primary research objective is to assess the feasibility of performing brief interventions without a specific topic in police custody settings in arrestees aged 15-35 years. The secondary research objectives include i) testing four strategies for engaging in BIs that maximize the chances of success of the BI; ii) identifying the determinants that can orient the practitioner's choice to use a specific strategy over another one; and iii) analysing the differences between individuals who engage in BIs and those who do not and, in those who do engage, the determinants of success of the intervention. METHODS: A two-step randomized and prospective study: i) randomization of eligible patients into 4 groups of 500 patients each; analysis of the response rates for each strategy; performance of the BI; and analyses of the associated factors and ii) a real-life, full-scale phase study evaluating the effectiveness of BIs performance of the BI; and analyses of the interventions. Analyses of the determinants of a positive response to BI, of success and of the topic of intervention will be conducted. EXPECTED RESULTS: The rates of BI performed, rates of success, and characteristics associated with response and with success are the main expected results. Additionally, the development and assessment of filter questions and an improved BI dedicated to primary prevention for police custody settings will be attained.

A data model for clinical legal medicine practice and the development of a dedicated software for both practitioners and researchers.

OBJECTIVE: To present a data model for clinical legal medicine and the software based on that data model for both practitioners and researchers. The main functionalities of the presented software are computer-assisted production of medical certificates and data capture, storage and retrieval. METHODS: The data model and the software were jointly developed by the department of forensic medicine of the Jean Verdier Hospital (Bondy, France) and an bioinformatics laboratory (LIMICS, Paris universities 6-13) between November 2015 and May 2016. The data model was built based on four sources: i) a template used in our department for producing standardised medical certificates; ii) a random sample of medical certificates produced by the forensic department; iii) anterior consensus between four healthcare professionals (two forensic practitioners, a psychologist and a forensic psychiatrist) and iv) anatomical dictionaries. The trial version of the open source software was first designed for examination of physical assault survivors. RESULTS: An UML-like data model dedicated to clinical legal practice was built. The data model describes the terminology for examinations of sexual assault survivors, physical assault survivors, individuals kept in police custody and undocumented migrants for age estimation. A trial version of a software relying on the data model was developed and tested by three physicians. DISCUSSION: The software allows files archiving, standardised data collection, extraction and assistance for certificate generation. It can be used for research purpose, by data exchange and analysis. Despite some current limitations of use, it is a tool which can be shared and used by other departments of forensic medicine and other specialties, improving data management and exploitation. Full integration with external sources, analytics software and use of a semantic interoperability framework are planned for the next months.

[Forensic medical examination of adolescent and adult victims of sexual assault or intimate partner violence who do not complain to the police - An observational study in Seine-Saint-Denis, France]. / Accueil en médecine légale des adolescents et adultes victimes de violences sexuelles ou de violences dans le couple n'ayant pas déposé plainte ­ étude observationnelle en Seine-Saint-Denis.

OBJECTIVES: to identify characteristics of victims of sexual assault or domestic violence who consulted in a Department of Forensic Medicine without a formal complaint to the police. METHODS: observational study (03/01/2014-08/31/2015) of individuals (age>15years) consulting in a Department of Forensic Medicine near Paris, France, after a sexual assault or domestic violence. Among the individuals who were examined in the department of Forensic Medicine, we compared the individuals who had not complained to the police to those who had complained to the police. RESULTS: A hundred and nine individuals have consulted without a prior complaint to the police, including 73 persons after domestic violence (i.e. 4% of all persons examined with or without a complaint to the police) and 36 persons after a sexual assault (i.e. 8% of all persons examined). Regarding domestic violence, the proportion of persons presenting recent traumatic injuries was lower among those who did not complain to the police than among those who did (64% vs. 78%, P=0.008). Regarding sexual violence, the persons who did not complain to the police were more frequently uncertain about the assault (42% vs. 13%, P<0.001), reported more frequently a recent alcohol or drug intake (42% vs. 26%, P=0.039) and less frequently showed extragenital traumatic injuries than the persons who did complain to the police (22% vs. 43%, P=0.016). CONCLUSION: the persons examined who had not complained to the police accounted for less than one in 20. The extension of the activity of a Department of Forensic Medicine to persons who do not want to be involved in a judicial process is not sufficient for the majority of victims to consult a forensic physician.

Social vulnerabilities and health conditions of arrestees in the Greater Paris area, France, in 2013: a multicentre cross-sectional study.

OBJECTIVE: The aim of this study was to describe the health and social conditions of arrestees, as compared to the general population. METHODS: We studied a sample of 600 adult arrestees in three locations in the Greater Paris area, prospectively included (February-May 2013). A descriptive analysis has been performed, then prevalence was estimated using an indirect standardisation according to age, based on data from a population-based, representative survey in the same area. RESULTS: Arrestees had a median age of 31 years; 92% were males. As compared to the general population, arrestees had a lower level of education (8.6 vs. 7.6%, p < 0.001), were more frequently unemployed (42.0 vs. 11.9%, p < 0.001) and in a difficult financial situation (43 vs. 11%, p < 0.001) and had less significant social support (48.1 vs. 87.9%, p < 0.001). They reported also more frequently a chronic health condition (54 vs. 36%, p < 0.001) and a limited health insurance coverage (36 vs. 15%, p < 0.001). CONCLUSION: Comparative analysis of male arrestees and males from the general population showed that the former had worse social and health conditions. These results argue for widespread medical interventions on all arrestees. Medical examination during detention could act as a gateway to health care and social support.

Violence at work: forensic medical examination of police officers assaulted while on duty: comparisons with other groups of workers in two centres of the Paris area, 2010-2012.

PURPOSE: To test for differences in somatic, psychic and functioning outcomes associated with assaults across four groups of workers, of which three are structurally at high risk of occupational violence. To report and compare job characteristics, characteristics of the assault and medical findings in police officers and other workers at the time of a forensic examination performed shortly after they complained for being assaulted while working. METHODS: A two-centre prospective study recruiting adult survivors of workplace violence who lodged a complaint to the judicial authorities and were examined by forensic physicians in the Paris area, between 2010 and 2012 over a 27-month period, was conducted. Victims were administered a dedicated questionnaire and filled in the peritraumatic dissociative experiences questionnaire. Bivariate and multivariate analyses were performed on collected data to account for potential biases. RESULTS: Compared to employees of public transports services, private security guards and other workers, police officers were less likely to report psychic disturbances and peritraumatic dissociative experiences, despite adverse factors such as a worse external working climate or more frequent exposure to workplace assaults. No differences were observed in terms of somatic symptoms or functional impairment across groups. CONCLUSIONS: Although structurally more exposed to adverse factors than other workers, police officers appeared to be more protected from negative outcomes. The reasons for this resilience should be more precisely investigated.

Intimate Partner Sexual Assault: Traumatic Injuries, Psychological Symptoms, and Perceived Social Reactions.

OBJECTIVE: To compare the consequences of sexual assault based on the relationship of the woman to her named assailant. METHODS: From January 2008 to March 2011, we conducted an observational and prospective study of females older than age 15 years who were examined at a sexual assault referral center. Data were collected and comparisons made between groups based on the victim's relationship to her named assailant: a current or former intimate partner (grouped as intimate partner), stranger, or acquaintance. Data were collected regarding the patients, assailants, and type of assault. At a 1-month follow-up examination, we evaluated clinical findings and reported reactions by the victim's friends, family, and acquaintances. We conducted descriptive analyses and searched for overall and pairwise differences among groups. RESULTS: There were 797 individuals seen during this time period. Thirty of the victims were male and were excluded from the study, leaving 767 females older than 15 years of age, 294 (38%) of whom attended the follow-up consultation. Simultaneous physical and sexual assaults were more frequent in intimate partner assaults than in assaults by unknown individuals or acquaintances: 55% (95% confidence interval [CI] 49-61) compared with 31% (95% CI 26-36) and 32% (95% CI 26-38; P<.001). One month after the initial examination, psychological trauma was noted in 92% of the patients and was evenly distributed among the three groups. Reactions from family members were similar for victims assaulted by intimate partners and other victims. CONCLUSION: Sexual assault by an intimate partner is associated with higher rates of extragenital trauma and similar rates of psychologic trauma and disrupted other relationships as that associated with assaults by strangers or acquaintances. Sexual assaults by intimate partners should be viewed as serious as assault by other assailants by law enforcement, the judiciary, and the public.

Expectations and perceptions of care among victims of sexual assault who first seek care from emergency, primary care and gynaecological doctors.

BACKGROUND: The role of health professionals is pivotal in providing support to victims of sexual assault. Our aim was to identify patient expectations of doctors after a sexual assault and to assess how they rated the doctors' responses. METHODS: We conducted a prospective observational study (May 2010-December 2012) involving victims of sexual assault (age >10 years) in a Department of Forensic Medicine near Paris, France. The patients included were those who had first sought care from a doctor prior to arriving at the Department of Forensic Medicine. Victims were asked by questionnaire and interviewed by the forensic physician about medical consultations before arriving at the Department, their expectations about those consultations and their feelings about the quality of support provided. Each patient's feelings were rated on a five-point scale. RESULTS: Among 1112 victims reporting sexual assault, 232 previously had a consultation, and were included in the study. Patients expected trauma care in 44% of cases, and received it in 40% (p=0.42), psychological support in 31% of cases, and received it in 21% (p=0.02), gynaecological care in 28%, and received it in 31% (p=0.52) and forensic support in 21%, and received it in 54% (p<0.001). The patients more frequently considered the provided support to be crucial when they received both forensic support and trauma care, psychological support or gynaecological care than when they only received trauma care, psychological support or gynaecological care (25% vs 3%, p=0.001). CONCLUSIONS: Physicians who are the first medical provider to see a patient after a sexual assault often fail to meet patients' expectations, particularly with regard to psychological support. Care received was perceived as best when physicians provided both forensic support and trauma care, psychological support or gynaecological care.

Development of bifunctional chelates bearing hydroxamate arms for highly efficient (64)Cu radiolabeling.

Convenient approaches for the synthesis of DOTHA2 and NOTHA2, two cyclic bifunctional chelates (BFCs) bearing hydroxamate arms, have been developed. These novel BFCs coordinate (64)Cu with fast kinetics at room temperature in a wide range of concentrations and pH. The corresponding radiochemical complexes showed high stability, low residual activity in various tissues, and fast clearance in normal mice. The ability to conjugate DOTHA2 to both a small peptide and a large protein is also reported.

Detainees in police custody in the Paris, France area: medical data and high-risk situations (a prospective study over 1 year).

BACKGROUND AND OBJECTIVE: The annual number of detainees held in police custody in France is approximately 700,000. Medical data regarding arrestees are scarce across countries. We present the medical characteristics of detainees kept in police custody, including addictive behaviours and high-risk medical situations. METHODS: We conducted a prospective study over 1 year in a suburban area near Paris. RESULTS: A total of 19,098 medical examinations were performed on 13,317 individuals. The examinations mainly concerned male subjects (18,116 of 19,098, 95 %). Median age was 24 years (range 13-83). Medical examination was requested by the detainee in 6,638 of 16,801 cases (40 %). Assaults were reported in 4,052 of 17,312 cases (23 %) and occurred at the time of arrest in most cases (2,243, 13 %). A total of 2,394 of 13,317 detainees (18 %) had at least one chronic somatic disorder including asthma (603, 5 %), diabetes (263, 2 %) and arterial hypertension (205, 2 %). A history of psychiatric disorder was reported by 6 % of individuals (674 of 11,787). Regular alcohol drinking was reported by 58 % of detainees. Illicit drug use mainly involved cannabis (4,021 cases, 30 %). In 14,661 of 19,098 cases (77 %), detainees were considered to be unconditionally fit for detention in custody, and 274 detainees (1 %) were declared unfit to be detained. CONCLUSION: The present study showed a high frequency of alcohol or substance use and reported assaults or traumatic lesions in arrestees. Attending physicians should pay particular attention to addictive behaviours and traumatic injuries in arrestees, both for immediate care and for prevention.

[Detainees in police custody in Seine-Saint-Denis (France): Medical data and high-risk situations, a descriptive study]. / Personnes placées en garde à vue en Seine-Saint-Denis : données médicales et situations à risque, étude descriptive.

OBJECTIVES: The number of detainees held in police custody in France increased up to 792,000 yearly in 2009. Medical examination is a right for every detainee. Our objective was to assess medical characteristics and addictive behaviours of arrestees. METHODS: In this study, we systematically evaluated arrestees detained in police custody in Seine-Saint-Denis, a suburban area near Paris over one year (June 1, 2010-May 31, 2011). RESULTS: A total of 22,379 medical examinations were performed. Males accounted for 94% of detainees. Median age was 23 (range: 13-78). In 2968 of 18,466 cases (16%), the detainee had at least one chronic somatic disease. Asthma, diabetes, and arterial hypertension were the most commonly encountered. A history of psychiatric disorder was reported in 819 of 16,697 cases (5%). Daily alcohol consumption was reported by 14% of detainees and 77% smoked tobacco. Drug use was reported by 40% of detainees, cannabis in most cases (38%), infrequently cocaine or crack (4%) or heroine (1%). Assaults were reported by 20% of detainees, at the time of arrest in most cases (11%). PERSPECTIVES: The present study showed the high frequency of addictive behaviours and reported assaults or traumatic injuries in arrestees. Attending physicians should pay particular attention to addictive disorders and recent traumatic lesions in arrestees, both for immediate care and for prevention.