[Investigation of a French cohort of neonatal anoxo-ischemic encephalopathy in the era of therapeutic hypothermia: Questions and answers]. / Analyse d'une cohorte française d'encéphalopathies néonatales anoxo-ischémiques à l'ère de l'hypothermie thérapeutique : questions­réponses.

OBJECTIVE: To improve knowledge of neonatal hypoxic-ischemic encephalopathy, a prospective, nationwide, population-based cohort of affected children is being set up between September 2015 and March 2017. METHODS: During this period, 794 cases are collected, with information on pregnancy, delivery, neonatal stay and outcome at the end of hospitalization. Clinical and parental questionnaire follow-up is planned until the child is 4 years old. RESULTS: This article presents the clinical presentation of the newborns included, the analysis of factors associated with short-term outcome at hospital discharge and the organizational factors associated with treatment with therapeutic hypothermia. CONCLUSION: These data illustrate the value of a prospective cohort to analyze the management of anoxo-ischemic encephalopathy in France.

[An epidemiological and evolutionary profile of occupational asthma of Tunisian workers]. / Profil épidémiologique et évolutif de l'asthme professionnel des travailleurs tunisiens.

INTRODUCTION: This study aims to identify the epidemiological and occupational characteristics of patients with occupational asthma (OA) and to assess their clinical evolution and occupational outcomes. METHODS: We carried out a descriptive epidemiological study over a period of five years (from 2012 to 2016) about the OA cases in the private sector reported in the Tunisian region of Zaghouan. RESULTS: All in all, 165 OA cases were reported during the study period, representing an annual incidence of 733.3 cases per 1,000,000 workers in the private sector. Our study population was composed predominantly (85.5%) of women, whose mean age was 41.5±6.8years. More than three quarters of the affected persons were working in the automobile industry, and most illnesses (77%) were attributable to isocyanates. The mean time to onset of the respiratory symptoms was longer for low molecular weight agents (13.6±3.1years) compared to high molecular weight agents (12.0±3.9years) (P=0.0006). The majority of OA cases (66.7%) lost their jobs. Job loss was significantly more frequent among asthmatic women and workers with OA due to isocyanates. Among the 62 cases of OA for whom risk factors were eliminated, 45 nonetheless remained symptomatic. CONCLUSION: Effective prevention strategies involving the various actors need to be implemented in work environments so as to reduce the frequency and the medico-legal repercussions of a disabling condition.

[Professional outcome after cancer disease in military population]. / Devenir professionnel après maladie cancéreuse chez des militaires actifs.

INTRODUCTION: The impact of cancer on working ability in the military environment remains a matter of concern. The primary aim of this study was to identify sociodemographic, professional and disease related factors influencing the professional outcome in the military population. METHODS: Descriptive, retrospective study on active military cancer patients treated in the oncology department of the Military Hospital of Tunis between January 2016 and December 2018. Data collection was based on a previously established survey sheet. The professional development was checked by phone calls. RESULTS: Our study included 41 patients. Mean age was 44 years±8.3. The population was predominantly male (56%). Seventy-eight percent of patients were non-commissioned officers. Most frequent primary tumors were breast (44%) and colorectal tumors (22%). The resumption of professional activity concerned 32 patients. Exemptions were granted to 19 patients (60%). Predictive factors identified in univariate statistical analysis associated with return-to-work were the stage of the disease, the performance status of patients at the time of diagnosis (P=0,001) and the need for psychological support (P=0,003). CONCLUSION: Several factors were involved in the resumption of professional activity after cancer disease, especially in the military population. It therefore seems essential to anticipate the return to work in order to overcome the difficulties that may be encountered during the recovery.

Predictive factors for the outcome of emotional and/or behavioural disorders in 18- to 48-month-old children after parent-child psychotherapy: Protocol of a European prospective cohort study.

OBJECTIVES: Several studies have shown that in young children, behavioural and/or emotional disorders are more difficult to manage than regulatory disorders. Moreover, data are lacking on outcome predictive factors. This article presents a short synthesis of previous research about outcome predictive factors in child psychiatry. It also describes the protocol of a longitudinal observational European multicentre study the main objective of which was to identify predictive factors of behavioural and emotional disorder outcome in toddlers after parent-child psychotherapy. The secondary objectives were to study predictive factors of the outcome in parents (anxiety/depression symptoms) and parent-child relationship. METHOD: In order to highlight medium-effect size, 255 toddlers (age: 18 to 48 months) needed to be included. Outcomes will be assessed by comparing the pre- and post-therapy scores of a battery of questionnaires that assess the child's symptoms, the parents' anxiety/depression, and the parent-child relationship. Multivariate linear regression analysis will be used to identify predictive factors of the outcome among the studied variables (child age and sex, socio-economic status, life events, disorder type, intensity and duration, social support, parents' psychopathology, parents' attachment, parent-child relationships, therapy length and frequency, father's involvement in the therapy, and therapeutic alliance). EXPECTED RESULTS AND CONCLUSION: This study should allow identifying some of the factors that contribute to the outcome of externalizing and internalizing disorders, and distinguishing between pre-existing and treatment-related variables. It should also help to identify children at higher risk of poor outcome who require special vigilance on the part of the therapist. It should confirm the importance of therapeutic alliance. TRIAL REGISTRATION: ID-RCB 2008-A01088-47.

Adaptation of the working alliance inventory to therapeutic interventions for early-age regulatory and behavioral symptoms: French versions of the infant-toddler WAI for parents and therapists.

OBJECTIVES: The therapeutic alliance, an essential component of the therapeutic process, has been investigated in adult and child therapy, but studies in the context of parent-infant or parent-toddler therapeutic interventions are scarce. This monocentric study aims to produce a French cross-cultural adaptation of a therapeutic alliance scale for the context of early consultations in a child and psychiatry department. METHOD: Fifty-five young children aged 3 to 30 months consulting for regulation or behavioral disorders and their mothers were included in the study. The working alliance inventory (WAI) was translated into French by two bilingual translators and adapted to early-age consultations in parent and therapist versions. Assessments of the child's symptoms and the parents' anxiety and depression were carried out at the start and end of therapy. We studied the association of the alliance with the initial clinical characteristics and with the outcome of the child and the mother. An exploratory factor analysis was performed considering the items most associated with expected outcomes. RESULTS: The alliance coded by the mother was lower in case of child behavioral problems and was associated with the mother and child outcome. Short versions of the infant-toddler WAI were developed based on factor analysis, highlighting four factors: positive goals and tasks, bond with the mother, alliance with the child, negative experience of care relationship. DISCUSSION: Results were similar to those found in therapy with adults or older children. The alliance issue in mother-baby therapies was as essential as in other therapy contexts. The short Infant-Toddler WAI resulting from this work must be validated in future studies.

Devir-onça: "Meu tio Iauaretê", de João Guimarães Rosa / My uncle Iauaretê / Mon oncle Iauaretê

O conto de João Guimarães Rosa intitulado "Meu tio o Iauaretê", publicado em 1961, permanece um texto singular da literatura brasileira. Por meio de um monólogo em situação dialógica, em um português oral sarapintado por expressões e termos em tupi, realiza-se o devir-onça de um ex-matador de onças que nelas encontra seu povo, seus parentes. A leitura enfatiza o caráter indomesticável desse texto ficcional e suas implicações antimetafísicas e políticas.

Written by João Guimarães Rosa and published in 1961, the short story "My uncle the Jaguar" remains a unique fictional text in the Brazilian Literature. By means of a monologue in a dialogical situation and written in an oral Portuguese entangled with expressions and words in Tupi, a becoming-jaguar of a previous jaguar-killer is progressively enacted. This jaguar killer finally recognizes the jaguars as his real folks, as his kinfolk. The article emphasizes the untamable character of Rosa's short story and develops its antimetaphysical and political implications.

Publié en 1961, le récit écrit par João Guimarães Rosa intitulé «Mon oncle le jaguar¼ reste un texte unique, singulier de la Littérature Brésilienne. A travers une sorte de monologue en situation dialogique, écrit dans une langue portugaise tacheté par des termes et des expressions en tupi, ce texte performe le devir-jaguar d'un ex tueur de jaguars qui finit par reconnaître ces félins comme son peupele, sa parenté. L'article met en relief le caractère indomptable de ce texte fictionnel et souligne ses implications anti-métaphysiques et politiques.

Sobre o conceito de inconsciente: entre filosofia e psicanálise / On the concept of the unconscious: between philosophy and psychoanalysis / Sur le concept d'inconscient: entre philosophie et psychanalyse

O presente artigo tem como objetivo realizar uma leitura do conceito freudiano de inconsciente, buscando inseri-lo em seu contexto histórico-epistemológico. Ao mesmo tempo, pretende-se estabelecer um diálogo entre ele e a noção de multidão de minorias, em especial a partir das ideias de inconstância e devir.

In this article, we carry out a reading of the Freudian's concept of the unconscious, willing to apprehend it within its historical-epistemological context. At the same time, we propose a dialogue between the concept of the unconscious and the notion of multitude of minorities, especially considering the ideas of inconstancy and becoming.

Cet article vise à effectuer une lecture du concept freudien d'inconscient, en cherchant à l'insérer dans son contexte historico-épistémologique. En même temps, on se propose à établir un dialogue entre celui-ci et la notion de multitude de minorités, notamment d'origine les idées d'inconstance et de devenir.

Criações e devires em filosofias e teatros menores: intercessões teatrais com Gilles Deleuze & Felix Guattari / Creations and becomings in minor philosophies and theaters: theatrical intercessions with Gilles Deleuze & Felix Guattari / Creaciones y devenimientos en filosofías y teatros menores: intercesiones teatrales con Gilles Deleuze y Felix Guattari

Este artigo trabalha as criações e os devires em filosofias e teatros menores, através da explicitação de tais procedimentos pela filosofia de Deleuze e Guattari. Assim, ao definirmos as noções de maioria, minoria, criações e devires-minoritários nos dois filósofos, mostraremos tais procedimentos como minoritários e criaremos a oportunidade de lermos tais processos ocorrerem no Teatro de Carmelo Bene, para investigamos no final um possível cotejamento entre estes pensamentos. Ao confirmarmos no final o teatro filosófico minoritário de Deleuze e Guattari, criaremos a ressonância indispensável que dará destaque e originalidade política e ética ao empreendimento construtivo dos dois autores.

This article works on the creations and becomings in minor philosophies and the theaters, through the explanation of such procedures by philosophy of Deleuze and Guattari. This way, when we define the notions of majority, minority, creations, and minor changes in both philosophers, we will show such procedures as minority and we will create the opportunity to read such procedures in the Theater de Carmelo Bene, to investigate, at the end, a possible comparison between such thoughts. When we conclude in a positive way the minority philosophical theater of Deleuze and Guattari, we will create an indispensable resonance that will give emphasis and political originality and ethics to the constructive enterprise of both authors.

Este artículo trabaja sobre creaciones y devenires en filosofías y teatros menores, a través de la explicitación de tales procedimientos por parte de la filosofía de Deleuze y Guattari. Así, cuando definimos las nociones de mayoría, minoría, creaciones y devenires minoritarios en los dos filósofos, mostraremos dichos procedimientos como minoritarios y crearemos la oportunidad de leer como tales procesos ocurren en el teatro de Carmelo Bene, para investigarmos al final una posible comparación entre estos dos pensamientos. Confirmando al final el teatro filosófico minoritario de Deleuze y Guattari, crearemos la resonancia indispensable que dará protagonismo y originalidad política y ética a la empresa constructiva de los dos autores.

[Course of a child born with a transfusion-transfusion syndrome from prenatal to college]. / Parcours d'un enfant né au décours d'un syndrome transfuseur-transfusé du prénatal au collège.

The literature concerning the neurocognitive evolution of children with transfusion-transfusion syndrome (TTS) is poor beyond the first year of life. It is therefore of particular interest to trace the developmental and management pathway, from the age of 18 months to 11 years, of a boy who presented with TTS in utero. This example illustrates the benefit of early multidisciplinary support and the diagnostic issues raised with the development of the child.

[Description of trajectories of patients with end-stage renal disease from the REIN registry]. / Description synthétique des trajectoires des patients insuffisants rénaux chroniques terminaux à partir du registre REIN.

CONTEXT AND OBJECTIVES: Since 2001, the aim of the REIN registry has been to identify patients suffering from end-stage renal disease and benefiting from replacement therapy in France. The analysis of trajectories aims to evaluate the flow of patients between the different types of treatment in order to better understand and predict patient pathways. The objective of this study was to analyse the incoming and outgoing flows at 1 year of patients prevalent in the REIN registry on 12/31/2017. METHODS: Flow analysis was carried out on patients prevalent on 12/31/2017 in the REIN registry by studying the before and after treatment modalities on 12/31/2016 and 12/31/2018. This analysis was initially carried out on all patients, then in sub-groups for each of the 5 treatment modalities. RESULTS: The analyses covered 85,472 patients prevalent on 12/31/2017. The overall analysis showed that more than 20% of patients had been diagnosed with end-stage renal disease the year before. Regarding inflow, there was a relative stability for patients treated with self-care hemodialysis, in-center haemodialysis, peritoneal dialysis, and graft, in contrast to patients treated with hemodialysis in a medical unit. Regarding outgoing flows, proportion of deaths at one year was 9%. Peritoneal dialysis was the modality with the highest outflow proportion at one year. CONCLUSION: Analysis of patients' trajectories shows variable evolution profiles according to treatment modality and thus could be a valuable tool in the evaluation and improvement of management and care in the field of end-stage renal disease.

Ten years psychosocial outcomes among adolescents following suicide attempts - early recurrence and psychosocial outcomes.

OBJECTIVES: A suicide attempt (SA) is a major risk factor of recurrent SA in adolescence and may be associated with psychological or social problems in the future. REPEATERS is a longitudinal study which examines the long-term psychosocial outcome of adolescents following attempted suicide. It focuses on the impact of early recurrence (i.e., within the first year of the index SA) - data which is, in fact, poorly documented. METHODS: Ten years after the index SA, a self-reporting questionnaire was sent to all adolescents who had attempted suicide and were followed up by the CHRU (Regional University Hospital Centre) de Nancy, France, between 1994 and 2003 and their parents. The purpose of this questionnaire was to assess psychosocial outcomes. Data concerning SA were collected retrospectively. RESULTS: After ten years, 146 of the 309 adolescents who had attempted suicide and were participating in the study had responded: 90% lived with a partner and 41% had children. The mean (SD) current emotional life of suicide attempt survivors scored 7.3 (2.3) on a scale of 0 to 10. Compared to the general population of the same age, responders felt more depressed than their peers (29% vs. less than 8% of males and 20% of females), had more suicidal thoughts (14% vs. 5%), and had more SAs (27% vs. 0.3%). Moreover, the risk of recurrence over the ten year period was associated with suicide recurrence in the first year after the index SA (odds ratio [OR]=2.3; 95% confidence interval [CI]=1.1-4.9) and with a lower level of education at ten years (OR=0.37; 95% CI=0.19-0.45). CONCLUSIONS: Although a favorable outcome was reported ten years after the event for the majority of adolescents who had attempted suicide, some with a lower level of education were nevertheless at increased risk of recurrence and depression. Post-intervention strategies are therefore essential in order to evaluate risk factors which may persist if not taken into consideration.

[Cancers associated with HIV: epidemiological, clinical characteristics, and becoming patients in the infectious disease department of Bamako]. / Cancers associes a l'infection a VIH : caracteristiques epidemiologiques, cliniques, et devenir des patients dans le service de maladies infectieuses de Bamako.

INTRODUCTION: The association between HIV and cancer is becoming more and more frequent, given the increased life expectancy of HIV positive patients with triple antiretroviral therapy. This association had not been documented in our service, hence the aim of this work. Our objectives were to describe the epidemiological and clinical characteristics and to determine outcome of patients with both pathologies. METHODS: We conducted a retrospective study based on hospitalization records from the infectious diseases department of Point G University Hospital from 2009 to 2014. All patients aged 15 years and older, HIV positive with a diagnosis of cancer were included with usable medical records. Data entry and analysis were done on Epi Info version 3.5.3. The variables studied were sociodemographic, immunological, virological, clinical and outcome. RESULTS: 51 cancer files were collected on 2525 patients (prevalence of 2%), among them 42 had the combination of cancer and HIV (1.7%). The majority were young adults (mean age 40.5 ± 8.9 years), 88.1% of whom were under 50 years of age and the majority were female (54.8%). HIV-1 was the predominant serotype (90.5%). The average CD4 T cell count was 111±106 cells/µl and 77.4% had less than 200 CD4/µl of blood. The majority (83.8%) were on HAART. Cancers classifying AIDS were predominant (90.5%) including Kaposi's disease (71.4%), non-Hodgkin's lymphoma (NHL) (14.3%) and cervical cancer (4.8%). We recorded 69% of deaths. The case-fatality rates were 66.7% for kaposi's disease and NHL (66.7%) and 50% for cervical cancer, respectively. CONCLUSION: Our study provides an overview of the association between cancer and HIV in the service. Cancers attributable to viral infections are the most numerous. A targeted prevention program and early detection of HIV as part of the test and treat strategy are essential.

INTRODUCTION: L'association VIH et cancer apparaît de plus en plus fréquente, compte tenu de l'augmentation de l'espérance de vie des patients VIH positifs avec la trithérapie antirétrovirale. Cette association n'avait pas été documentée dans notre service, d'où le but de ce travail.Nos objectifs étaient de décrire les caractéristiques épidémio-cliniques et de déterminer le devenir à court terme des patients atteints de cancer au cours du VIH. MÉTHODOLOGIE: Nous avons conduitune étude rétrospective sur les dossiers d'hospitalisation du service des maladies infectieuses du CHU du Point G de 2009 à 2014. Tous les patients âgés de 15 ans et plus, VIH positif chez qui un diagnostic de cancer a été retenu avec dossier médical exploitable ont été inclus. La saisie et l'analyse ont été faites sur Epi Info version 3.5.3.Les variables étudiées étaient sociodémographiques, immunovirologiques, cliniques et évolutives. RÉSULTATS: Au total, 51 dossiers de cancers ont été colligés sur 2525 patients (prévalence de 2%), parmi eux 42 étaient atteints de l'association cancer et VIH (1,7%). Il s'agit en majorité d'adultes jeunes (âge moyen de40,5 ± 8,9 ans)dont 88,1% avaient moins de 50 ans et majoritairement de sexe féminin (54,8%). Le VIH-1 était le sérotype prédominant (90,5%). Le taux moyen de lymphocytes T CD4 est de 111±106 cellules/µl et 77,4% avaient moins de 200 CD4/µl de sang. La majorité (83,8%) était sous trithérapie antirétrovirale. Les cancers classant sida prédominaient (90,5%) dont la maladie de Kaposi (71,4%), le lymphome non hodgkinien (LNH) (14,3%) et cancer du col de l'utérus (4,8%). Nous avons enregistré 69% de décès. Les taux de létalités étaient respectivement de 66,7% pour la maladie de kaposi et le LNH(66,7%) et de 50% pour les cancers du col de l'utérus. CONCLUSION: Notre étude permet de faire un aperçu de l'association cancer et VIH dans le service. Les cancers associés à des infections virales sont les plus fréquentes. Un programme de prévention ciblée et de dépistage précoce du VIH dans le cadre de la stratégie tester et traiter sont indispensables.

Segregação do desejo na "escolha" profissional e seus impasses subjetivos no trabalho docente / La segregación del deseo en la "elección" profesional y sus impases subjetivos en el trabajo docente / The segregation of desire in professional "choice" and its subjective impasses in teaching work / Ségrégation du désir dans le « choix ¼ professionnel et ses impasses subjectifs dans le travail de l'enseignant

O artigo tematiza a importância do trabalho como meio de afirmação para o sujeito em sua inscrição no circuito da construção civilizatória. Problematiza a investigação da atividade docente, convocada a um processo de ressignificação em um cenário em que as escolhas profissionais parecem cada vez mais apartadas do desejo e assentadas em promessas de satisfação desvinculadas da história de cada qual. Por meio da interrogação de fragmento de caso clínico e de comentários extraídos da internet, o objetivo do texto é lançar questões sobre os impactos do atual imperativo de gozo nas escolhas profissionais e na atuação docente. Conclui-se que a formação universitária, em um pacto com a pesquisa, precisa encontrar meios de transcender a lógica da sobrevivência e subsistência e recuperar o que se encontra na essência da palavra.

El artículo discute la importancia del trabajo como medio de afirmación del sujeto en su registro en el circuito de la construcción civilizadora. Problematiza la investigación de la actividad docente, convocada a un proceso de reencuadre en un escenario en el que las elecciones profesionales parecen cada vez más separadas del deseo y basadas en promesas de satisfacción ajenas a la historia del otro. Mediante el interrogatorio de un fragmento de un caso clínico y comentarios extraídos de internet, el objetivo del texto es plantear interrogantes sobre los impactos del imperativo actual del disfrute en las elecciones profesionales y el desempeño docente. Se concluye que la formación universitaria, en pacto con la investigación, necesita encontrar caminos para trascender la lógica de la supervivencia y la subsistencia y recuperar lo que se encuentra en la esencia de la palabra.

The article discusses the importance of work as a means of affirmation for the subject in his registration in the circuit of civilizing construction. It problematizes the investigation of teaching activity, summoned to a process of reframing in a scenario in which professional choices seem increasingly separated from desire and based on promises of satisfaction unrelated to each other's history. Through the interrogation of a fragment of a clinical case and comments extracted from the internet, the objective of the text is to raise questions about the impacts of the current imperative of enjoyment on professional choices and teaching performance. It is concluded that university education, in a pact with research, needs to find ways to transcend the logic of survival and subsistence and recover what is found in the essence of the word.

Cet article a pour propos l'importance du travail comme moyen d'affirmation du sujet pour son inscription dans le circuit de la construction civilisatrice. Il problématise l'investigation de l'activité d'enseignement, convoquée à un processus de ressignification dans un contexte où les choix professionnels semblent de plus en plus séparés du désir et basées sur des promesses de satisfaction sans lien avec l'histoire de chacun. Au moyen de l'étude d'un fragment de cas clinique et de commentaires retirés d'Internet, ce texte a pour but de soulever des questions sur les impacts de l'actuel impératif de jouissance sur les choix professionnels et sur la pratique de l'enseignement. La conclusion est que la formation universitaire, en coopération avec la recherche, doit trouver des moyens d'aller au-delà de la logique de survie et de subsistance et de retrouver ce que renferme l'essence du mot.

Rumo a uma forma revisada de pensamento e prática psicanalíticos: a evolução da teoria analítica da mente / Toward a revised form of analytic thinking and practice: the evolution of analytic theory of mind / Hacia una forma revisada de pensamiento y práctica psicoanalíticos: la evolución de la teoría analítica de la mente / Vers une forme révisée de la pensée et de la pratique psychanalytiques: l'évolution de la théorie analytique de l'esprit

RESUMO O autor descreve o nascimento da psique conforme cinco teóricos da psicanálise: Freud, Klein, Fairbairn, Winnicott e Bion. Vê isso como fundamental para que possa evoluir uma nova e fértil forma de pensamento e clínica psicanalíticos. A concepção de mente apresentada por cada um desses autores se desenvolve: começa como aparelho para o pensamento (em Freud, Klein e Fairbairn) e torna-se um processo localizado na experiência (em Winnicott e Bion). O trabalho deles inaugura e transforma radicalmente tanto o pensamento daqueles que os precederam como dos que os sucederam. Ao contar essas "histórias" do surgimento da mente, e descrever esse conceito na obra de cada um daqueles teóricos, o autor oferece não apenas sua estrutura narrativa e esclarecimentos acerca do trabalho deles, mas também suas próprias interpretações e extensões dessas ideias.

ABSTRACT The author describes the start of psyche according to five of the psychoanalytic theoreticians: Freud, Klein, Fairbairn, Winnicott and Bion. This is seen as fundamental so there can be a new and fruitful way of thinking and psychoanalytical clinic. The concept of mind presented by each of these authors is developed: it starts as means to the thoughts (Freud, Klein and Fairbairn) and becomes a process found in experience (Winnicott and Bion). Their work completely unveils and transforms both the way of thinking of those coming before them as well as those who came after them. When telling this 'stories' on the origin of the mind, and describing this concept from each of the work of these theoreticians, the author offers, not only his narrative and clarification on their work, but also his own interpretations and scope on these ideas.

RESUMEN El autor describe el nacimiento de la psique según cinco teóricos del psicoanálisis: Freud, Klein, Fairbairn, Winnicott y Bion. Considera fundamental para que pueda evolucionar una nueva y fértil forma de pensamiento y clínica psicoanalíticos. La concepción de la mente presentada por cada uno de esos autores se desarrolla: empieza como aparato para el pensamiento (en Freud, Klein y Fairbairn) y se convierte en un proceso situado en la experiencia (en Winnicott Bion). Ese trabajo inaugura y trasforma radicalmente tanto el pensamiento de aquellos que los precedieron como de los que los sucedieron. Al contar esas "historias" del origen de la mente, y describir ese concepto en la obra de cada uno de aquellos teóricos, el autor ofrece no solamente su estructura narrativa y explicaciones sobre su trabajo, sino también sus propias interpretaciones y extensiones de esas ideas.

RÉSUMÉ L'auteur décrit la naissance de la psyché selon cinq théoriciens de la psychanalyse : Freud, Klein, Fairbairn, Winnicott et Bion. Il considère ce fait fondamental pour qu'une manière neuve et fertile de pensée et de clinique psychanalytiques puisse évoluer. La conception d'esprit présentée par chacun de ces auteurs se développe : elle commence comme un appareil pour la pensée (chez Freud, Klein et Fairbairn) et devient un processus situé dans l'expérience (chez Winnicott et Bion). Leur travail inaugure et transforme radicalement aussi bien la pensée de ceux que les ont précédés, que celle de ceux que les ont succédé. Lorsqu'il raconte ces « histoires ¼ de l'apparition de l'esprit et décrive ce concept chez l'œuvre de chacun de ces théoriques, l'auteur offre non seulement sa structure narrative et les éclaircissements concernant leur travail, mais aussi ses propres interprétations et les extensions de ces idées.

Psicanálise ontológica ou "O que você quer ser quando crescer?" / Ontological psychoanalysis or "What do you want to be when you grow up?" / Psicoanálisis ontológico o "¿Qué quieres ser cuando crezcas?" / Psychanalyse ontologique ou « Que voulez-vous devenir quand vous serez grand ? ¼

O autor discute as diferenças entre o que chama de psicanálise epistemológica - relacionada ao conhecimento e à compreensão, tendo como principais autores Freud e Klein - e o que chama de psicanálise ontológica - relacionada ao ser e ao tornar-se, tomando nesse caso como principais referências Winnicott e Bion. Argumenta que, com Winnicott, a psicanálise deixa de estar centrada no sentido simbólico do brincar, que passa a ser visto como experiência. Já com Bion a psicanálise deixa de estar centrada no sentido simbólico dos sonhos, e a experiência de sonhar passa a ser considerada em todas as suas formas. A ideia é que a psicanálise epistemológica envolve sobretudo a busca por compreender sentidos inconscientes. Por sua vez, o objetivo da psicanálise ontológica é permitir que o paciente descubra sentidos de maneira criativa e que, nesse processo, se torne mais plenamente vivo.

The author discusses the difference between what is called epistemological psychoanalysis-related to knowledge and understanding, having Freud and Klein as main authors - and ontological psychoanalysis, related to being and becoming, having Winnicott and Bion as main articulators in this case. The author says that, with Winnicott, psychoanalysis is not centered in symbolic meanings for playing and playing becomes an experience. According to Bion, psychoanalysis is not centered in symbolic meanings from dreams and the dreaming experience is then considered in all ways. The idea is that epistemological psychoanalysis mainly includes the search for understanding unconscious meanings. On the other hand, the objective of the ontological psychoanalysis is to allow the patient to find meanings in a creative way, and during this process it becomes completely active.

El autor analiza aborda las diferencias entre lo que denomina psicoanálisis epistemológico - relacionado con el conocimiento y la comprensión, teniendo como autores principales a Freud y Klein - y lo que denomina psicoanálisis ontoló-gico, relacionado al ser y a llegar a ser, tomando como articuladores principales en este caso a Winnicott y Bion. Argumenta que, con Winnicott, el psicoanálisis deja de centrarse en el sentido simbólico de jugar y jugar pasa a tomarse como experiencia. Por otro lado, con Bion, el psicoanálisis deja de centrarse en el sentido simbólico de los sueños y la experiencia de soñar pasa a ser considerada en todas sus formas. La idea es que el psicoanálisis epistemológico involucra, principalmente, la búsqueda de la comprensión de sentidos inconscientes. Por su parte, el objetivo del psicoanálisis ontológico es permitir que el paciente descubra sentidos de forma creativa, y que en este proceso se torne más plenamente vivo.

L'auteur discute les différences entre ce qu'il appelle psychanalyse épistémologique - qui a un rapport avec les connaissances et la compréhension, dont les auteurs les plus importants sont Freud et Klein - et ce qu'il appelle psychanalyse ontologique, qui a un rapport avec l'être et le devenir, en prenant comme articulateurs principaux Winnicot et Bion. Il argumente que chez Winnicott la psychanalyse n'est plus centrée sur le sens symbolique de jouer, et le jouer est alors pris en tant qu'expérience. D'autre part, chez Bion la psychanalyse n'est plus centrée sur le sens symbolique des rêves et l'expérience de rêver est alors considérée dans tous ses aspects. L'idée, c'est que la psychanalyse épistémologique concerne surtout la poursuite de la compréhension des sens inconscients. L'objectif de la psychanalyse ontologique est, à son tour, de permettre que le patient découvre les sens de façon créative, et que pendant ce processus devienne pleinement plus vivant.

[Umbilical Artery Doppler Study Role In The Monitoring And Obstetric Management Of High-Risk Pregnancies]. / Apport De L'Echo-Doppler Dans Le Suivi Des Grossesses A Risque.

OBJECTIVE: to compare aspects of the diastolic component of umbilical artery flow with fetal fate parameters. MATERIAL AND METHODS: this was a prospective, cross-sectional study at the Kaolack Regional Hospital over 6 months including patients with an at-risk pregnancy and a gestational age greater than 20 SA. The aspect of umbilical artery flow, umbilical artery IR and cerebro-placental index were studied.We compared the velocity data with the rates of fetal suffering, low birth weight and perinatal mortality. The statistical analysis was done with EPI info software version 7, Excel 2010 and SPSS 20.0 with a p-value of less than 5%. RESULTS: 46 patients were included with an average age of 24.54 years. The mean gestational age was 33.7 AS. The diastolic component of umbilical artery flow was null in 19.6%; reversed in 10.9%; decreased in 21.7% and normal in 47.8%. Confrontation with fetal fate parameters found a rate of 78.6% fetal suffering in the null or reversed diastolic components group compared to 34.4% in the non-zero diastolic components group. For low birth weight, this rate was 92.9% compared to 28.1%. The perinatal mortality rate was 64.2% compared to 12.5%. CONCLUSION: The umbilical artery Doppler study plays a major role in the monitoring and obstetric management of high-risk pregnancies. Our results demonstrate the correlation between a diastolic component of the flow of the pathological umbilical artery and the adverse outcome of the pregnancy at risk.

OBJECTIF: confronter les aspects de la composante diastolique du flux de l'artère ombilicale aux paramètres du devenir fœtal. MATÉRIEL ET MÉTHODES: il s'agissait d'une étude prospective, transversale à l'Hôpital régional de Kaolack sur 6 moisincluant les patientes avec une grossesse à risque et un âge gestationnel supérieur à 20 SA. Etaient étudiés l'aspect du flux de l'artère ombilicale, l'IR de l'artère ombilicale et l'index cérébro-placentaire. Nous avons confronté les données vélocimétriques au taux de souffrance fœtale, de faible poids de naissance et de mortalité périnatale. L'analyse statistique a été faite avec le logiciel EPI info version 7, Excel 2010 et SPSS 20.0 avec une p-value inférieure à 5%. RÉSULTATS: 46 patientes étaient incluses avec un âge moyen était de 24,54 ans. L'âge gestationnel moyen était de 33,7 SA. La composante diastolique du flux de l'artère ombilicale était nulle dans 19,6% ; inversée dans 10,9% ; diminuée dans 21,7% et normale dans 47,8%.La confrontation avec les paramètres du devenir fœtal trouvait un taux de souffrance fœtale de 78,6% dans le groupe des composantes diastoliques nulles ou inversées contre 34,4% dans le groupe des composantes diastoliques non nulles. Pour le faible poids de naissance ce taux était de 92,9% contre 28,1%. Concernant le taux de mortalité périnatale on notait 64,2% contre 12,5%. CONCLUSION: L'étude Doppler de l'artère ombilicale joue un rôle majeur dans la surveillance et la prise en charge obstétricale des grossesses à risque. Nos résultats démontrent la corrélation entre une composante diastolique du flux de l'artère ombilicale pathologique et l'issue défavorable de la grossesse à risque.

[Breech Presentation: CNGOF Guidelines for Clinical Practice - Benefits and Risks for the Neonate and Child of Planned Vaginal Delivery versus Elective Cesarean Section]. / Présentation du siège. Recommandations pour la pratique clinique du CNGOF ­ Bénéfices et risques pour l'enfant de la tentative de voie basse en comparaison de la césarienne programmée.

OBJECTIVE: To provide guidelines regarding the benefits and risks for the neonate and the child of planning vaginal delivery versus planning elective cesarean section in case of term breech presentation. METHODS: MedLine and Cochrane Library databases search and review of the main foreign guidelines. RESULTS: In case of term breech presentation, planned vaginal delivery might be associated with an increased composite risk of perinatal mortality or occurrence of a combined outcome of serious neonatal morbidity in comparison to elective cesarean section (LE2). In case of planned vaginal delivery of term breech presentation, the risk of perinatal mortality is around 1‰ (LE3). It is potentially less but still exists in case of elective cesarean section (LE2). Risks of neonatal trauma - especially fracture of clavicle and breech hematoma -, Apgar score lower than 7 at 5minutes, and need for neonatal intubation and ventilation, are increased in case of planned vaginal delivery (LE2) and are around 1% (LE3). However, no difference has been demonstrated between planned vaginal and planned cesarean delivery regarding neurodevelopmental outcomes at 2 years (LE2), cognitive and psychomotor outcomes between 5 and 8 years (LE3), and adult intellectual performances (LE4). CONCLUSIONS: In case of term breech presentation, risks of severe complications for neonate and child are low in case of planned vaginal delivery or elective cesarean section. Short-term benefit/risk balance for the neonate might favor elective cesarean section but long-term morbidity seems to be similar whatever the delivery route (Professional consensus).

Vivências traumáticas no ciclo gravídico-puerperal / Traumatic experiences in the pregnancy-puerperal cycle / Expériences traumatiques dans le cycle dela grossesse puerpérale / Vivencias traumáticas en el ciclo embarazo-puerperio

No imaginário social é comum a fantasia de que a mulher é tomada de sentimentos nobres ao receber um filho. Entretanto, a experiência clínica ensina que a maternidade pode ser um momento de intenso mal-estar, expresso sob a forma de conflitos, sintomas e angústia. O presente artigo procura mostrar, por meio de reflexões teóricas e apresentações de vinhetas clínicas, que o ciclo gravídico-puerperal é um processo em que a mulher está exposta a vivenciar algo da ordem do traumático capaz de desorganizá-la psiquicamente.

In the social imaginary, there is a widespread fantasy in which woman is taken of noble feelings when giving birth to a child. However, clinical experience teaches that motherhood can be a time of intense malaise, expressed in the form of conflicts, symptoms and distress. This paper tries to show, through theoretical reflections and presenting clinical vignettes, that the pregnancy-puerperal cycle is a process in which women are exposed to traumatic experiences that are capable of disorganizing them psychically.

Dans l'imaginaire social, il est courant de penser que la femme éprouve des sentiments nobles lorsqu'elle met au monde un enfant. Cependant, l'expérience clinique montre que la maternité peut être une période de malaise intense, exprimée sous forme de conflits, de symptômes et de détresse. Cet article essaie de montrer, par le biais des réflexions théoriques et des présentations de vignettes cliniques, que le cycle grossesse-puerpérale est un processus dans lequel la femme est exposée à quelque chose de traumatisant capable de provoquer en elle un désordre psychique

En el imaginario social, es común la fantasía de que la mujer es colmada de sentimientos nobles al recibir a un hijo. Sin embargo, la experiencia clínica enseña que la maternidad puede ser un momento de intenso malestar, expresado en forma de conflictos, síntomas y angustia. El presente artículo busca mostrar, mediante reflexiones teóricas y presentaciones de viñetas clínicas, que el ciclo embarazo-puerperio es un proceso en que la mujer está expuesta a vivir experiencias de orden traumático capaces de desorganizarla psíquicamente.

Gemäß der sozialen Vorstellung soll es üblich sein, dass eine Frau edle Gefühle entwickelt, wenn sie ein Kind empfängt. Die klinische Erfahrung lehrt jedoch, dass die Mutterschaft eine Zeit intensiven Unwohlseins sein kann, ausgedrückt in Form von Konflikten, Symptomen und Leiden. Dieser Artikel versucht aufzuzeigen, mittels theoretischer Überlegungen und der Beschreibung klinischer Vignetten, dass der Zyklus zwischen Schwangerschaft und Wochenbett ein Prozess ist, während dem die Frau einer traumatischen Erfahrung ausgesetzt ist, die sie psychisch desorganisieren kann.

A lógica da falta ou a falta da lógica: como responder ao desafio de compreender o suicídio? / The logics of absence or the absence of logics: how to answer the challenge of understanding suicide? / La lógica de la falta o la falta de lógica: ¿cómo responder al desafío de entender el suicidio? / La logique du manque ou le manque de logique: comment répondre au défi de comprendre le suicide?

Neste artigo, discuto como a proposta de uma compreensão filosófica sobre o suicídio é um desafio e como um viés teórico multidisciplinar, aqui proposto por meio de um breve contraponto entre antropologia e psicanálise, apresenta potenciais heurísticos e epistemológicos no desvelamento do fenômeno. Apresento também a narrativa de um caso de pesquisa etnográfica para incorporar alguns elementos na discussão sobre o suicídio.

In this paper, I discuss how challenging it is to propose a philosophical understanding on suicide and how a theoretical and multidisciplinary bias, here as a concise counterpoint between the Anthropology and the Psychoanalysis, has heuristic and epistemological potential to unveil the phenomenon. I also introduce the narrative of a case from an ethnographic research to incorporate elements in the discussion about suicide.

En este artículo, discuto cómo la propuesta de una comprensión filosófica sobre el suicidio es un desafío y cómo un enfoque teórico multidisciplinario, propuesto aquí a través de un breve contrapunto entre Antropología y Psicoanálisis, presenta potenciales heurísticos y epistemológicos para desvelar el fenómeno. También presento la narración de un caso de investigación etnográfica para incorporar algunos elementos en la discusión sobre el suicidio

Dans cet article, je discute comment la proposition d'une compréhension philosophique sur le suicide est un défi et comme un biais théorique multidisciplinaire, ici proposé par un bref contrepoint entre l'anthropologie et la psychanalyse, présente des potentiels heuristiques et épistémologiques dans le dévoilement du phénomène. J'expose aussi la narrative d'un cas d'une recherche ethnographique pour incorporer certains éléments dans la discussion concernant le suicide.