ABSTRACT
INTRODUCTION: The concept of policy management in psychiatry requires knowledge representations of the "mad", the "mentally ill" and "depressed" by the people. It is therefore to highlight the diversity of definitions that it attributes to individual psychiatric disorders, particularly by cultural norms typically associated with geographic locations. To do this, we successively study the forms of stigmatisations broadly, and then by site, and the causes of thereof. But this does not suffice for the design of any policy in this area must also take into account the attitudes and behaviours of the population vis-à-vis the existing psychiatric facilities globally and per site. DESIGN OF STUDY: The treatments were carried out using data from the socio-anthropological and epidemiological "Mental Health in the general population: images and realities" made by the French Collaborating Centre of WHO for research and training Mental Health (WHOCC, Lille, France) and the Directorate of Research, Studies, Evaluation and Statistics (DREES) with 40 000 people aged 18 and older in metropolitan France and in the departments of overseas between 1999 and 2003. The techniques used range from descriptive statistics to multivariate analysis (correspondence analysis and multiple ascending hierarchical classification). RESULTS: The images of the "madness", the "mentally ill" or the "depression" in the French population are disparate. Nevertheless, some characteristics are found with high frequency: the "depressive" is rather seen as an isolated person, the "mentally ill" as a mental defective with bizarre speech, while "crazy" would rather characterized by violence (delusions and violent towards others, beat his family, incest). The "mentally ill" is sometimes defined by these last criteria. These images are not influenced by knowledge of a relative suffering from mental illness or a psychiatric episode experienced by the interviewee. The causes of mental illness (the "madness" and "mentally ill"), two contradictory trends have expressed. Some believe it has a physical origin, and in that case the healing is difficult and care must be hospitable. Others believe it was originally a non-physical (social), and in this case, recovery is possible, and care must be ambulatory. People surveyed in some sites have homogeneous opinions in this regard: Berk, Thuir or Guéret, the first opinion is mainly expressed, whereas the opposite trend was observed in Villejuif, Niort, Lille, Poitiers, Paris15, Paris10. In contrast, for depression, the cause is, for almost the entire population, non-physical. Overall, 41% of French people support psychiatric hospitals, while 32% oppose, preferring ambulatory solutions. In fact, opinions differ so widely among survey sites. They are not influenced by the images of people surveyed vis-à-vis the "madness", the "mentally ill" or the "depression". The way of organizing psychiatric sectorization (taken care rather intra-hospital versus extra-hospital, number of agents, etc.) does not influence either the image of "mad", the "mentally ill" or "depression" in population, nor the opinions vis-à-vis psychiatric hospitals. We deduce that these images are generated by other factors, probably cultural factors.
Subject(s)
Depressive Disorder/psychology , Health Surveys , Hospitals, Psychiatric , Mental Disorders/psychology , Psychotic Disorders/psychology , Public Opinion , Social Stigma , Adolescent , Adult , Aged , Delusions/psychology , Depressive Disorder/diagnosis , Depressive Disorder/therapy , Female , France , Health Policy , Humans , Intellectual Disability/diagnosis , Intellectual Disability/psychology , Intellectual Disability/therapy , Male , Mental Disorders/diagnosis , Mental Disorders/therapy , Middle Aged , Prognosis , Psychological Distance , Psychotic Disorders/diagnosis , Psychotic Disorders/therapy , Social Values , Violence/psychology , World Health Organization , Young AdultABSTRACT
INTRODUCTION: The aim of this study was to evaluate frequency and management of vascular complications in renal allograft. PATIENTS AND METHODS: We performed retrospective analysis of patients who underwent renal allograft from 2001 to 2006 at our university hospital center. In order to access peri- and postoperative vascular complications, data were also obtained from donors and receivers, as well as organ procurement and renal transplant procedure. RESULTS: One hundred and seventy-nine files were analyzed with a median follow-up of 40 months, mean age of donors was 40.4+/-11.2 years and 46.01+/-10.6 years for receivers. Seventy-two allograft patients had at least one vascular complication, with 32 cases of renal arterial stenosis, 28 cases of hematoma with surgical exploration required in seven cases, four cases of arterial thrombosis, two cases of venous thrombosis and one arterial dissection. Our series underlines that tobacco abuse in donors is a risk factor for vascular complication (p=0.043), as well as glomerular nephropathy (p=0.0185), coagulopathy (p=0.0165) and hemodialysis (p=0.02) are risk factors for receivers. Multiple arteries in renal allograft (p=0.03) and calcification on aortic patch (p=0.0274) would present a greater risk of postoperative complications. Our results demonstrate that the following parameters i.e., postoperative transfusion (p=0.011), heparin therapy (p=0.0085), immunosuppression (p=0.0478), and peri-operative aminovasopressive drugs (p=0.086) could also be implicated in vascular complication occurrence. CONCLUSION: A careful selection of donors remains a major factor for renal allograft quality, however arterial evaluation and coagulopathy detection in receivers must also be performed prior to transplantation procedure. A multidisciplinary approach (nephrologist, urologist, anesthesist) will optimize vascular ischemia delay and also reduce early and late vascular complications, which could have possible consequences on renal allograft and patient survival.
Subject(s)
Kidney Transplantation/adverse effects , Vascular Diseases/etiology , Adult , Female , Hematoma/etiology , Humans , Male , Middle Aged , Renal Artery Obstruction/etiology , Retrospective Studies , Time Factors , Vascular Diseases/epidemiologyABSTRACT
A retrospective analysis of 211 consecutive complaints treated at the Direction of Health and Social Assistance of Paris was undertaken in order to specify the nature of the complaints and to evaluate their pertinence as an indicator of quality of care. The majority of complaints concern public and private health establishments, in particular surgery and psychiatric services. Although the study confirms the dysfunctioning of the organisation of services and also of therapeutic methods and medical treatments, the evaluation of iatrogenic risks and their avoidable nature is difficult and requires precise instruction. Complaints seem to be a neglected indicator of quality, yet they concern information that is accessible and could, if used with other information, be a first milestone in the vigilance of medical treatments.
