The unique identifier as one of the essential tools for steering universal health coverage: The case of Morocco / L'identifiant unique comme un des instruments indispensables au pilotage de la couverture sanitaire universelle, le cas du Maroc.

INTRODUCTION: Morocco is carrying out several actions to generalize basic compulsory health insurance (CHI). Managing this project requires coordination, information sharing, and the commitment of all actors to the goal of covering an additional 22 million people. One of the key factors for achieving this objective is the implementation of a unified registration system. PURPOSE OF THE RESEARCH: The aim is to analyze the existing situation and the feasibility of implementing a unified registration system, and to describe the potential positive impact of the latter on the extension of CHI. RESULTS: This work is based on a diagnosis of the current situation. It draws on the legal framework, all available documents and figures, and on an analytical reading supported by existing literature. It reveals that due to the inadequacy or even the absence of an appropriate legal basis, each managing body has its own registration system. The lack of a unified system has given rise to a number of constraints. These concern, among other things: (i) mobility between or within schemes, which does not operate smoothly because it leads to re-registration (ii) inadequate monitoring of double benefit claims, which is the case for more than one scheme, due to insufficient and hesitant anti-fraud action (iii) the sharing and use of reliable data, which hinders decision making, evaluation, and monitoring. CONCLUSIONS: It is essential to adopt legal texts that will provide the basis for a unified system with regulations enabling the participation of all stakeholders, with the aim of steering the roll-out of CHI effectively and efficiently.

Introduction: Le Maroc mène, depuis quelques années, plusieurs actions permettant de généraliser l'assurance maladie obligatoire (AMO). Le pilotage de ce chantier nécessite la coordination, le partage d'informations et l'engagement de tous les acteurs afin de couvrir 22 millions de personnes supplémentaires. L'un des éléments clés pour optimiser la réalisation de cet objectif consiste à mettre en place un système unifié d'immatriculation. But de l'étude: Analyser l'existant et la faisabilité de la mise en place d'un système unifié d'immatriculation, tout en précisant ses retombées positives sur l'extension de l'AMO. Résultats: Ce travail, fondé sur un diagnostic, appuyé par l'arsenal juridique, des documents et des chiffres disponibles ainsi qu'une lecture analytique renforcée par la littérature existante, a permis de constater que, du fait de l'insuffisance voire l'absence d'un soubassement juridique adapté, chaque organisme gestionnaire a son propre système d'immatriculation. L'absence d'un système unifié gêne notamment : 1) la mobilité entre régimes ou intra-régimes, étant donné qu'elle ne se fait pas de manière fluide car elle génère la ré-immatriculation ; 2) le contrôle du double bénéfice d'un régime insuffisamment organisé et incapable de lutter contre la fraude ; 3) le partage et l'exploitation de données fiables empêchant d'assurer de manière appropriée le suivi, l'évaluation et la prise de décision. Conclusion: Il est indispensable d'adopter des textes juridiques pour fonder un système unifié qui permettra l'encadrement et l'engagement de toutes les parties prenantes dans l'objectif de piloter la généralisation de l'AMO avec efficacité et efficience.

Transcultural skills for early childhood professionals.

Context: Transcultural skills are especially useful for those involved in the perinatal period, when parents and babies must adapt to one another in a setting of migration a long a focus of transcultural clinical practice. Objective: The aim of this article is to provide useful transcultural skills for any health care worker (e.g., psychologists, child psychiatrists, midwives, family doctors, pediatricians, specialized child-care attendants, and social workers) who provide care or support to families during the perinatal period. It highlights the cultural aspects requiring attention in relation to representations of pregnancy, children's needs, obstetric complications, and postnatal problems. Taking into account the impact of culture on clinical evaluation and treatment can enable professionals to distinguish what involves cultural representations of pregnancy, babies, and sometimes of disease from what is associated with interaction disorders or maternal psychopathology. Methods: After explaining the relevance of transcultural clinical practices to provide migrant mothers with better support, we describe 9 themes useful to explore from a transcultural perspective. This choice is based on the transcultural clinical practice in our specialized department. Results: The description of these 9 themes is intended to aid in their pragmatic application and is illustrated with short clinical vignettes for specific concepts. We describe situations that are extreme but often encountered in liaison transcultural clinical practice for maternity wards: perinatal mourning with cultural coding, mediation in refusal of care, cultural misunderstandings, situations of complex trauma and of multiple contextual vulnerabilities, and difficulties associated with acculturation. Discussion: The transcultural levers described here make it possible to limit cultural misunderstandings and to promote the therapeutic alliance. It presupposes the professionals will concomitantly analyze their cultural countertransference and acquire both the knowledge and know-how needed to understand the elements of cultural, political, and social issues needed to develop clinical finesse. Conclusion: This combined theoretical-clinical article is intended to be pedagogical. It provides guidelines for conducting transcultural child psychiatry/psychological interviews in the perinatal period aimed at both assessment and therapy.

[Taking care of an unaccompanied minor's body at the Maison des adolescents]. / Prendre en charge le corps et son histoire, parcours d'une mineure non accompagnée à la Maison des adolescents.

The care of unaccompanied young exiles in public health care facilities for adolescents often requires teams to adapt their capacities for institutional containment. We describe the case of a 16 year old female migrant adolescent, whose follow-up occurred at the Maison des adolescents of the Cochin Hospital, with several healthcare workers involved. The healthcare team had to reflect on the meaning of her somatic symptoms and why the referring adults were so worried (such as fear of death). We describe how we articulated somatic and psychological care for this adolescent girl living in a precarious situation.

Multimodal co-therapy for unaccompanied minors: a qualitative study.

BACKGROUND: Unaccompanied refugee minors-or unaccompanied minors-are children and adolescents who have been separated from parents and other relatives and are not being cared for by an adult. Unaccompanied minors are a vulnerable population, with numerous stressors and complex psychiatric symptoms necessitating specialized mental health care. This study explores patients' experiences of a Multimodal Co-Therapy for Unaccompanied Minors (MUCTUM), which encompasses cultural, biological, narrative & institutional approaches to care. METHODS: MUCTUM is a co-therapy program for unaccompanied minors, with a psychiatrist, psychologist, native-language interpreter, and caseworker for each patient. In this qualitative study, we interviewed adolescents about their experiences with MUCTUM and analyzed these semi-structured interviews using a phenomenological framework (Interpretative Phenomenological Analysis). RESULTS: Qualitative analysis of 16 interviews discovered that unaccompanied minors felt misunderstood before participating in MUCTUM, describing a sense of strangeness and loneliness in relation to psychiatric symptoms. Several youths experienced triple stigmatization: of being unaccompanied minors, of suffering from psychotrauma, and of being mental health patients. We further describe three overarching domains that inform on MUCTUM support to unaccompanied minors: (1) A safe space for unaccompanied minors; (2) Helpful interventions during therapy; and (3) Narrating one's story can "set us free" if guided carefully by care providers. CONCLUSION: This study suggests that MUCTUM therapy may efficiently support unaccompanied minors' mental health by acknowledging their hierarchy of needs. Psychotherapeutic strategies include creating a safe place, providing culturally appropriate care and patient-centered therapy, addressing concrete problems, supporting relationships, and making use of limited reparenting in therapy. Delayed and progressive inquiry about traumatic events may be beneficial. Replication of these findings and their field application is warranted.

Stereological Evidence of Non-Selective Hippocampal Neurodegeneration, IGF-1 Depletion, and Behavioral Deficit following Short Term Bilateral Adrenalectomy in Wistar Rats.

The development of animal models to study cell death in the brain is a delicate task. One of the models, that was discovered in the late eighties, is the induction of neurodegeneration through glucocorticoid withdrawal by adrenalectomy in albino rats. Such a model is one of the few noninvasive models for studying neurodegeneration. In the present study, using stereological technique and ultrastructural examination, we aimed to investigate the impact of short-term adrenalectomy (2 weeks) on different hippocampal neuronal populations in Wistar rats. In addition, the underlying mechanism(s) of degeneration in these neurons were investigated by measuring the levels of insulin-like growth factor-1 (IGF-1) and ß-nerve growth factor (ß-NGF). Moreover, we examined whether the biochemical and histological changes in the hippocampus, after short-term adrenalectomy, have an impact on the cognitive behavior of Wistar rats. Stereological counting in the hippocampus revealed significant neuronal deaths in the dentate gyrus and CA4/CA3, but not in the CA2 and CA1 areas, 7 and 14 days post adrenalectomy. The ultrastructural examinations revealed degenerated and degenerating neurons in the dentate, as well as CA4, and CA3 areas, over the course of 3, 7 and 14 days. The levels of IGF-1 were significantly decreased in the hippocampus of ADX rats 24 h post adrenalectomy, and lasted over the course of two weeks. However, ß-NGF was not affected in rats. Using a passive avoidance task, we found a cognitive deficit in the ADX compared to the SHAM operated rats over time (3, 7, and 14 days). In conclusion, both granule and pyramidal cells were degenerated in the hippocampus following short-term adrenalectomy. The early depletion of IGF-1 might play a role in hippocampal neuronal degeneration. Consequently, the loss of the hippocampal neurons after adrenalectomy leads to cognitive deficits.

Transcultural and familial factors in bilingualism and language transmission: A qualitative study of maternal representations of French-Maghrebi Arabic bilingual children.

This qualitative exploratory study examined transcultural and familial factors involved in bilingualism and minority language transmission among French and Arabic-speaking children. Participants included 30 children aged 4 to 6 years, born in France, and their bilingual French-Maghrebi Arabic-speaking parents. Children's bilingual language profiles were assessed with the ELAL Scale for Maghrebi Arabic (minority language) and the Neel Scale for French (majority language). Mothers participated in qualitative interviews about cultural and language practices and representations. Interview contents were compared with the children's language profiles. Results indicated that parents closely associated the transmission of the Arabic language with their cultural heritage transmission. The parents of fluent bilinguals had a strong desire to transmit the minority language. Mothers of minority language dominant bilingual children reported little perception of change in their lives since migration. Half of the mothers of majority language dominant bilingual children reported relationship or emotional difficulties with their children. Four minority language transmission types were identified: direct parent-child transmission; indirect transmission through private classes; indirect transmission through visits to family in the parents' native countries; and alternative transmission by another family member. Direct parent-child transmission was most frequent among the fluent bilinguals. Families' processes of hybridity were related to language transmission and bilingual development of children. Parental cultural affiliations to native country were related to minority language transmission. Perception of change since migration and affiliation to host country may also play a role in harmonious bilingual development. Moreover, the quality of family relationships can affect minority language transmission.

Cultural Competence of Professionals Working With Unaccompanied Minors: Addressing Empathy by a Shared Narrative.

BACKGROUND: The number of migrant youth traveling without parents continues to rise in Europe and North America. Some of t hem leave their home countries on their own and find themselves in a new country, separated from their family and cut off from their cultural roots. Besides those who leave to study, work, and pursue a better life, others are escaping war-torn countries. They need adequate social, educational, and therapeutic spaces, where they can feel entitled to speak. Social workers often ask about how they can understand these young people better so that they can provide them with better care (cope with their trauma and suspicion, deal with the cultural distance between the adolescents and their social workers, etc). AIM: At Cochin Hospital in Paris, we led a participative action-research program to transmit cultural competence to social workers who provide care for these youth. The aim was to develop an approach to help these young migrants to share their representations about themselves and to train these social workers to encourage this sharing in a culturally sensitive manner. METHODS: This study used a qualitative method that mixed narrative and transcultural approaches. Two researchers met each youth and social worker with an interpreter-cultural mediator three times (once a month) to assess changes in their relationships during the study. The youth were asked to bring three items of their choice, representing their past, present, and future. They could use their imagination and creativity. We also used the circle test described by Cottle for this purpose. We used a phenomenological approach to analyze the interviews. RESULTS AND DISCUSSION: This study included 29 young people from 13 different countries and 29 social workers. A transcultural approach appears to be a useful framework for reactivating their identity construction process. It promotes the emergence of cultural representations and takes their experiences before, during, and after migration into account. We assisted them in developing their ability to produce a thorough narrative of their bicultural adolescences and simultaneously helped their social workers to develop their cultural competence. CONCLUSION: Together, a transcultural approach and methods stimulating the production of narrative are relevant ways to help children to describe their representations of themselves, especially those who have learned to protect themselves by remaining silent. This protocol could be useful for both preventive action and therapy for psychotrauma.

[Unaccompanied Minors: Individual Trajectories Confronting Politics]. / Les mineurs non accompagnés : des destins individuels qui interrogent le politique.

Objectives The article presents the clinical description and discussion of a 17 years old Moroccan unaccompanied minor who migrated on his own to France. This case illustrates the complexity of the foreign unaccompanied minors' trajectories and the challenges of the clinical and institutional accompaniment provided in France. In the lights of the results of our clinical work and research, we suggest transcultural tools and perspectives that facilitate the construction of a narrative and that reinforce trust with the professionals-care givers working along with this population. Creativity is needed in the care of foreign isolated young people, in the absence of the family. Past traumatic experiences in these youths' lives hinder the process of building trust in the host country's educational accompaniment. Method In the framework of our action research, we describe the transcultural therapy setting created by our team to address the unaccompanied minors' psychological distress. Aiming to encourage the emergence of a life narrative that had been obstructed and ruptured by traumatic experiences, we resort to various tools facilitating the storytelling (objects, circle test, mediators interpreters, transcultural interpretations). Results The discussion follows three stances: the anthropological perspective focusing on the specific situation of the harraga-young people wandering both on the psychic and physical levels-, the political perspective, and the trauma clinic perspective. The enhancement and deepening of the cross-cultural skills of social workers strengthen their resources and provide them with better tools to accompany these young people. Additionally, results highlight the impact of the political discourse and strategies in the social workers' self-perception and the strains it creates in their daily work. Conclusion The transcultural approach addressed to unaccompanied minors relaunches the identity construction process in adolescence, impeded by their traumatic journey in migration. This implies restoring coherence in the life path of young people despite the rupture caused by the migration, often reactivated by new separations during the repetitive changes of foster homes. The unaccompanied minors have the possibility, through this clinical setting to depict an accurate representation of themselves, to develop narratives that can outgrow the preconceptions associated with their status, opening a brighter way for their individual destinies.

[Assessment and health needs of unaccompanied minors]. / État des lieux et besoins de santé des mineurs non accompagnés.

Unaccompanied minors are particularly vulnerable due to their pathway marked with multiple bereavements and constant uprooting. They find themselves confronted with the ordeal of mistrust due to administrative contradictions between the need to protect and immigration control. They are particularly at risk of developing psychiatric pathologies. Care must be multidisciplinary and in continuity with the educational support, taking into account the young person's original culture.

[Caregivers of North African origin faced with Islamist radicalisation]. / Le soignant d'origine maghrébine face à la radicalisation islamiste.

Supporting teenagers in search of ideality sometimes requires accepting and understanding the movements present in the process of Islamist radicalisation. It is therefore necessary to understand the implicit dimension to this notion of radicalisation and what it arouses in each of us. For caregivers with a North African immigrant background, it is a question of implementing their countertransference in order to guarantee unconditional acceptance, and to establish a bond to deliver better care.

[Clinical approach to linguistic plurality in a mother and infant welfare protection centre]. / Travail clinique autour de la pluralité linguistique en protection maternelle et infantile.

Many children supported by professionals from the mother and infant welfare protection centre grow up in a plurilingual environment. Taking into account this plurilingualism provides better understanding of the relationships which the children establish with their environment. This can also help them to engage in a transgenerational transmission as well as in multiple cultural affiliations.

[Initiating psychiatric care for young, isolated foreigners]. / Initier un suivi psychiatrique chez les jeunes isolés étrangers.

The various traumatic events experienced by young isolated foreigners can weaken them psychologically and cause psychiatric decompensation. A qualitative study, carried out by the Maison de Solenn and the Avicenne hospital, aimed to provide better understanding of the conditions for initiating psychiatric care with these adolescents. The different results show that this type of care for these young migrants must be cross-cultural and multi-disciplinary.

[Adolescent vulnerabilities and radicalisation]. / Vulnérabilités adolescentes et radicalisation.

Radicalisation resonates with the psychological vulnerabilities of adolescents. The ups and downs encountered as they attempt to construct their identity and their need to dominate favour the destructive nature of young people lacking a sense of filiation and belonging. An adolescent's engagement corresponds to a search for limits, with an adherence to religious values and to a group to establish self-esteem. Subjectification, authorising the adolescent to separate themselves from their parents and their values through a period of crisis must be supported.

[Growing up as a migrant, rites of passage in the Maghreb]. / Grandir en situation de migration, rituels de passage au Maghreb.

In a context of migration, some parents experience difficulties in passing on their culture and their knowledge, which makes it difficult to achieve reciprocal recognition and to establish a feeling of filiation and heritage. In this context, maintaining the rites of passage enables their symbolic effectiveness and creativity to be maintained. Circumcision, in particular, is a key stage of this process in the Maghreb.

[Drawing, a tool to use with unaccompanied foreign minors]. / Le dessin, support de soins aux mineurs isolés étrangers.

Supporting unaccompanied foreign minors requires a different clinical approach. These youngsters must be given individualised support to help them make the transition from exile and loss, to an existence as an individual, yet still a son or daughter. The drawing, as a transcultural and atemporal imprint, constitutes a tool enabling these young people to bring to the surface their unconscious thought processes, to exist and to come into being with dignity.

Increased pro-inflammatory cytokines, glial activation and oxidative stress in the hippocampus after short-term bilateral adrenalectomy.

BACKGROUND: Bilateral adrenalectomy has been shown to damage the hippocampal neurons. Although the effects of long-term adrenalectomy have been studied extensively there are few publications on the effects of short-term adrenalectomy. In the present study we aimed to investigate the effects of short-term bilateral adrenalectomy on the levels of pro-inflammatory cytokines IL-1ß, IL-6 and TNF-α; the response of microglia and astrocytes to neuronal cell death as well as oxidative stress markers GSH, SOD and MDA over the course of time (4 h, 24 h, 3 days, 1 week and 2 weeks) in the hippocampus of Wistar rats. RESULTS: Our results showed a transient significant elevation of pro-inflammatory cytokines IL-1ß and IL-6 from 4 h to 3 days in the adrenalectomized compared to sham operated rats. After 1 week, the elevation of both cytokines returns to the sham levels. Surprisingly, TNF-α levels were significantly elevated at 4 h only in adrenalectomized compared to sham operated rats. The occurrence of neuronal cell death in the hippocampus following adrenalectomy was confirmed by Fluoro-Jade B staining. Our results showed a time dependent increase in degenerated neurons in the dorsal blade of the dentate gyrus from 3 days to 2 weeks after adrenalectomy. Our results revealed an early activation of microglia on day three whereas activation of astroglia in the hippocampus was observed at 1 week postoperatively. A progression of microglia and astroglia activation all over the dentate gyrus and their appearance for the first time in CA3 of adrenalectomized rats hippocampi compared to sham operated was seen after 2 weeks of surgery. Quantitative analysis revealed a significant increase in the number of microglia (3, 7 and 14 days) and astrocytes (7 and 14 days) of ADX compared to sham operated rats. Our study revealed no major signs of oxidative stress until 2 weeks after adrenalectomy when a significant decrease of GSH levels and SOD activity as well as an increase in MDA levels were found in adrenalectomized compared to sham rats. CONCLUSION: Our study showed an early increase in the pro-inflammatory cytokines followed by neurodegeneration and activation of glial cells as well as oxidative stress. Taking these findings together it could be speculated that the early inflammatory components might contribute to the initiation of the biological cascade responsible for subsequent neuronal death in the current neurodegenerative animal model. These findings suggest that inflammatory mechanisms precede neurodegeneration and glial activation.

[The issue of death drawn by children]. / La question de la mort dessinée par les enfants.

Embracing death and finding the right words to represent it is a dangerous exercise when the death is traumatic and when it remains suspended on emotions and affects. The cross-cultural consultation enables the trauma to be developed and makes room for rituals and words. The children's drawings come to represent the traumatic transfer of the connections and fears, and the need to reconstruct a cultural cocoon.

Ameliorative effects of resveratrol on liver injury in streptozotocin-induced diabetic rats.

The objective of this study was to investigate the ameliorative property and potential mechanism of resveratrol (RVT) in a dose of 10 mg/kg for 15 consecutive days against liver injury in streptozotocin-induced diabetic rats. Diabetic rats significantly (P < 0.05) exhibited liver injury manifested by increased aspartylaminotransferase, alanine aminotransferase, and bilirubin; disturbed liver weight to body weight; and confirmed by hematoxylin and eosin staining. Liver from diabetic rats exhibited significant increase in malondialdehyde level and significant decrease in reduced glutathione, glutathione-S-transferase, quinone reductase, catalase, and superoxide dismutase. Diabetic rats showed significant disturbance in serum lipid profile. Treatment with RVT significantly (P < 0.05) abrogated diabetes-induced perturbation in these parameters and liver histology. These data suggest that RVT treatment is associated with promising hepatoprotective effect against diabetes-induced liver damage via reduction of serum glucose level and oxidative damage and improving serum lipid profile.

Goitrogenic activity of p-coumaric acid in rats.

The effects of three natural phenolic acids (caffeic, ferulic, and p-coumaric) on the rat thyroid gland were examined in a 3-week oral-treatment study. Forty male Wistar albino rats, divided into groups of 10 rats each and fed iodine-rich diet, were administered by gastrointestinal tube saline (control), caffeic acid, ferulic acid, or p-coumaric acid at a dose level of 0.25 micromol/kg/day for 3 weeks. The mean absolute and relative thyroid weights in caffeic, ferulic, or p-coumaric acid groups were significantly increased to 127 and 132%, 146 and 153%, or 189 and 201% compared to control value, respectively. Histological examination of the thyroids of p-coumaric acid group revealed marked hypertrophy and/or hyperplasia of the follicles. Caffeic or ferulic groups showed slight to moderate thyroid gland enlargement. Thyroid lesions in p-coumaric acid group were associated with significant increases in cellular proliferation as indicated by [(3)H]thymidine incorporation. In addition, the goitrogenic effect of p-coumaric acid was further confirmed by significant decreases (50%) in serum tri-iodothyronine (T(3)) and thyroxine (T(4)), and a parallel increase (90%) in serum thyroid stimulating hormone (TSH) compared to control group. These results indicate that administration of p-coumaric acid at relatively high doses induces goiter in rats.