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Objectives The objectives of this paper are to explore the impact of psychological trauma and migration on a mother's ambivalence regarding her relationship with her child and to explore the effect on the child's "continuity of being." Methods Literature on the ambivalence of mothers who have experienced trauma and migration is reviewed. The authors present the hypothesis that the presence of trauma and/or migration exacerbate the phenomenon of ambivalence and that it may impact early interactions in mother-infant dyads. The stories of three migrant dyads are presented to illustrate these processes. Results Pregnancy is a period of psychological and identity reorganisation during which a mother's ambivalence is as necessary as it is structuring for the child to come. The stories of the three mother-infant dyads presented in this paper highlight the impacts of migration and of traumatic experiences on entering motherhood in a foreign country. These mothers' representations of their children are affected by their ambivalence; the "child as a savior" and the "child as a persecutor" are in constant conflict within the mothers' psyche. The act of giving life is rooted in the mothers' histories and brings into question their very identities, their parentage and affiliations, as influenced by the hardships they have experienced. The arrival of a child is both a vulnerability factor as well as a source of tremendous resiliency. Therefore, it is essential to reflect on how to best welcome these mother-infant dyads in order to offer adapted and culturally sensitive care. Conclusion This paper offers a deeper review of a clinical reality often encountered in infant mental health with migrant and refugee populations. The perinatal period coinciding with migration is one of increased vulnerability and of potential revival of traumatic events. Giving birth in exile, especially when struggling with psychological trauma may impact maternal representations of their children. Children may then carry the burden of their histories or, inversely, become a source of creative potential for the mother-infant dyad. A transcultural approach is essential for a better understanding of the complex processes involved in becoming a mother in the context of trauma and/or migration and to improve care for mothers and their developing offspring.

The tension between conflicting values can result in disagreements within the nursing team. Faced with a crucial, serious and irreversible decision, deontological ethics are no longer sufficient: they must be combined with an ad hoc ethical meeting. Team deliberation is based on a 'moral contract' between the team members who undertake to respect ethical principles and the rules of the ethics of discussion, as shared guidelines.

Conflicts between families and caregivers in a nursing home have multiple causes centred (but not exclusively) on the interest of the resident. Intrafamily conflicts can lead to tensions between families and caregivers. Alzheimer's disease changes the relations with the patient's family members when they are involved in the care, which can lead to a division within the family. This article discusses the sources of difficulties between families and caregivers and ways of managing and above all preventing them.

Claude Bernard and Louis Pasteur will meet on various occasions, scientific prizes were awarded by Claude Bernard to Louis Pasteur, Claude Bernard's lessons were followed by Louis Pasteur at the Faculty of Science or at the College de France, and friendly relationship were established. But the essential lies in a posthumous controversy where Claude Bernard, denying the role of microbes in the fermentation, seems to criticize Pasteur's assertions and, later, his method and vision. We shall report here the exchanges which concern these two scientists and, beyond that, the scientific approach.

Schools are a place within which teenagers' anxieties are expressed, as well as those of adults, in the difficult confrontation with otherness, in a context of conflictual globalisation. The school is a key player in the prevention of terrorism, through the elaboration of these tensions which it can allow. The Métisco team offers school mediation programs, in order to help professionals fulfil this mission.

The social workers tell to be more and more often exposed to the religious reference table of the people they help and confronted to internal conflicts in the teams when it is a question of delimiting the borders of the religious freedom of expression in a laic frame. Besides they observe processes of affiliations-reaffiliations which pass by unchecked uses of religious practices, in particular when it concerns muslims people, which tends to become among young people of popular districts, and more marginally among the middle-class teenagers, in search of a reassuring orthopraxie, the support of a militant action for a project of new value identities disqualified or assigned, at risk of falling over to the communitarianism or the radicalization.

The impact of wounds and narcissistic conflicts can favour a murderous acting out. From a psychoanalytical point of view, narcissistic positions tinged with cynicism and envy in particular are identified, on a background of a pathology of ideals and the melancholisation of the social link. This article looks back at the attack in Paris in January 2015 through statements taken from social discourse.

Disagreements and conflicts have a negative impact on the satisfaction and the performances of working team members. Young doctors in training are part of the health care team. The management of the disagreements with which they are confronted is a part of their professionalization process.To clarify and analyze the disagreements between GP trainees and their seniors in patients care and their consequences in doctor curriculum.Qualitative descriptive study. Five focus groups including a total of 25 Parisian trainees were performed to explore situations of disagreements with their seniors about patients care. Phenomenical analysis was performed by two researchers.Thirty-seven situations were reported. A number of potential sources of conflicts were highlighted. Factors that can transform a disagreement into an insoluble conflict were identified. The consequences of these disagreements on the quality of care and their impact on the empowerment of trainees were analysed. Number of disagreements related patients facing end of life. Specificities of emergency contexts and ambulatory practice were underlined. The role of the hierarchical link in the genesis and the development of the conflicts was confirmed. The personality of the trainee, his conception of responsibility, the exchange of knowledge, the "commercial" aspects of doctors practice can be at the origin of conflicts.The disagreements can play a positive role in trainees empowerment. A training in the management of anticipated or known conflicts can usefully clarify and optimize the hidden curriculum of the medical students towards professionalism.

Circumcision dates back to ancient times, nowadays, this ritual is practiced mainly in the context of Jewish and Muslim religions. The purpose of this article is to give urologists elements of reflection on the act according to the ethical principles of autonomy, beneficence, non-maleficence and justice. According to a Kantian vision, priority should be given to the respect and wishes of the individuals. In contrast, for the utilitarian theory, circumcision can be justified by a contribution to the happiness of the majority of community members at the expense of a given few. In the event of a request for ritual circumcision, urologists find themselves in the middle, uncomfortable for some, questioning the ethics of its meaning. The main pitfall for the surgeon remains in respecting the child's autonomy.

Adolescent medicine is not a specialty but constitutes a specific clinical practice. The majority of teenagers go through adolescence without necessarily requiring systematic medical monitoring For others, it is a period that reveals past and/or present events that can combine with one another and be a source of morbidity: post-traumatic symptoms, familial dysfunction, behavioral problems unmasking a psychiatric disorder, onset of chronic disease... Medical follow-up of adolescents brings to light unique clinical profiles reflecting the existence of familial, social and/or scholastic rupture(s). Herein, through the introduction of the concept of rupture, we describe the principals of pragmatic medical management. This approach emphasizes that, first and foremost, the teenager must be reassured as to the proper functioning of his/her body, so that, in parallel or secondarily, psychotherapy can be envisaged. This strategy, while providing a guide for an individual physician, demonstrates that, in certain cases, he/she can work in tandem with a multidisciplinary hospital unit, in which all care functions can be mobilized around the youth.

High dose buprenorphine (HDB), commonly known as Subutex(®), is nowadays largely prescribed as a replacement therapy for major opiate dependence. Its sublingual administration allows a decrease in the withdrawal syndrome accompanying opiate abuse cessation. Over the past few decades, epidemiological data on people on replacement therapy have emphasized an increase in the misuse of Subutex(®) and more specifically intravenous injections of HDB. These growing practices pave the way to major physical consequences or even death. Several studies have highlighted the infectious, vascular, venous and arterial (pseudo-aneurysm) complications stemming from this habit. Among the possible vascular complications, we can notice the presence of abscess, venous thrombosis, phlegmons, skin necrosis, cellulite, and profound and superficial thrombophlebitis at injection sites. These can evolve into chronic edemas of the tips and subcutaneous nodules. The Popeye syndrome is one of the possible complications of this misuse. This syndrome is characterized by the swelling of both sides of the forearms and hands. These edemas tend to become persistent and to be paired with tissue changes such as skin thickening. Besides, the increase in the hands volume can occur bilaterally or sometimes in an asymmetrical way, accentuated on the hand of the non-dominant limb. This syndrome does not decrease, or just a little, after the stoppage of injections. It can have a psychological, social, psychopathological and esthetic impact.In this article, we will focus on the clinical case of a 43-year-old man, who is hospitalized in an addictology unit for massive injections of HDB. This patient suffers from a Popeye syndrome as well as from an alcoholic dependence.Following the description of psychopathological disorders, our analysis will originate from a clarification relative to the specificities of the practice of intravenous HDB injection to better sharpen the understanding of these misuses in their psychopathological and clinical aspects. We will discuss some proposals for interventions aiming at taking better care of the people suffering from a drug addiction characterized by the injection of HDB replacement therapy.Adam requested an admission in an addictology ward for treatment of a self-medication by Subutex started 4 years ago. A certain awkwardness can be perceived when he lays his highly damaged and marked hands on the desk. His upper limbs, thus on display, have tripled in volume: this indicates the presence of a Popeye syndrome, consequence of repeated Subutex injections. These observations lead us to question the function and the sense of this injection behavior in the mental economy, as this repeated behavior engages the body specifically. This bruised body, marked with repeated injection holes has become a place of inscription, of representation that shows the impossibility to access other ways of expression. In this sense, taking action is becoming an act of speech. Within this speech, we can notice the existence of a profound state of uneasiness. To put up with the painful feeling of inner emptiness that is calling for a necessary filling, aiming at re-establishing a frail balance, Adam appeals to repeated injections. However, when the tortured body signifies its incapacity to receive an ultimate injection, thus showing its limits and the destruction it is undergoing, it is no longer possible to resort to Subutex injections. As a consequence, Adam came up with the idea of quitting. The withdrawal was initiated by himself and not coupled with medical care. It has led him to feel a gap, beyond the physical uneasiness. Adam has tried to fill in this unbearable feeling of empty body with tobacco, alcohol and food. The body, highly mobilized, translates the presence of a physical conflict where a massive mental anxiety is expressed in a hidden way. During the interview, Adam also addressed the repetitive familial pattern and the transgeneration effects. He seems to be fully aware of these.Several perspectives can be addressed as part of Adam's treatment and especially cognitive-behavioral therapies as they could prove to be of a certain interest. The aim of this therapy would thus be to assess the motivation for change in order to begin a psychotherapeutic work based on personal adherence to the cessation of this misuse. This could be set up in parallel with an anxiety management work.A better understanding and an extensive knowledge of the possible complications linked to the misuse of HDB seems necessary to sensitize and better inform people who suffer from high-risk behaviors and also to enable a more adapted care.

The war in Columbia is the source of permanent and widespread violence, of which the civilian population, notably rural, is the main victim. What are the effects of the conflict's violence on individuals and on society? Medical-psychological teams from Médecins Sans Frontières France worked in Tolima, a region particularly affected by the conflict, between 2001 and 2008, and were able to study the complexity of the forms of violence and their consequences. This article is the first of two presenting an analysis backed up by personal accounts.

Evaluate the typology of violence in hospital setting, study the psychophysiological state of care givers dealing with the aggression and provide appropriate training.Single centre, observational.A first anonymous questionnaire was given to a sample of emergency and intensive care providers in Narbonne Hospital. The parameters studied included: demographics data, the Trait Anxiety Inventory test, the typology of aggressions, and the psycho-physiological state of subjects dealing with the aggression. Robert Paturel, an instructor of French Special Forces (Recherche-Assistance-Intervention-Dissuasion [RAID]), has provided training for the management of violence. A second questionnaire assessed satisfaction for proposed formation.Forty-one questionnaires were returned. The rates of verbal and physical violence touching care givers were respectively 97 % and 41 % (median of 7years [1-36] experience on the job). Eighty-five percent of care givers wanted training in psychology of conflict and 93 % wanted a formation with a self-defense aspect. The first reason of violence was drugs and alcohol abuse. The "tunnel effect" during stress was identified in 34 % of care givers, and 20 % were unaware of its nature. Twenty-one percent of care givers spontaneously adopting a safe distance of more than 1m during a conflict had been physically assaulted versus 63 % for those staying less than 1m (P=0.03). The proposed formation, including psychology of conflict and self-defense, was satisfactory to all care givers who participated (median score 9/10 [7-10]).The verbal and physical violence affecting emergency departments is a common phenomenon warranting appropriate training. The proposed formation included the comprehension of the conflict causality, self-defense and self-control.

The purpose of this article is to analyze media coverage of the health crisis created by the chikungunya epidemic on Reunion Island in 2005/2006. In reaction to nformation provided to the public, the media overstated the sanitary risk. Analysis of the press corpus corresponding to that period reveals an exaggerated account of the epidemic aimed at echoing the genuine distress expressed by victims and their family. Based on the feedback principle, the article suggests a relationship between this situation and information provided to the public about the crisis.

Recently, cognitive neuroscience has shed new light on our understanding of the neural underpinning of humans' morality. These findings allow for a fundamental questioning and rethinking of the alleged dichotomy between reason and emotion, that has profoundly shaped both moral philosophy and moral psychology. Functional neuroimaging and neuropsychology studies have provided strong arguments favoring a dynamic and interdependent interaction between rational and emotional processes in the brain. Yet another fundamental issue remains largely unexplored: the dissociation between certain behaviours and the moral judgments that seem to precede them. The importance of this dissociation was highlighted in a study of psychopathic patients during which they preserved their moral judgments while frequently engaging in completely non moral behaviour. Such dissociation could result from the cognitive difference between an objective moral judgement with no personal consequence, and a subjective behavioural choice that has effective or potential personal consequences. Consequently, the results of moral dilemma experiments would differ widely depending whether they explore objective or subjective moral evaluations. That these evaluations involve two distinct neural processes should be taken into account when exploring the neural bases of human morality.

What is the meaning behind elderly patients' symptoms? What place does the patient's complaint have? What is the relevance of a form of therapeutic support for these patients? Some psychoanalytic insights.

The objectives of this research are to identify employee dissatisfaction in two seniors' residences and to find resolutions to these problems. Conflicts between employees from two different services are not unusual in health care. It remains a major preoccupation for supervisors. Such a conflict arose in a seniors' residence between employees from the food services and the health care members. At every opportunity the quarreling groups would antagonize each other. They were all self-proclaimed experts when it came to the nutritional needs of the residents. The employees were convinced they knew more about the likes and dislikes of the residents than anyone, even more than the nutritionist and the family. The directors wanted to know what originated such conflicting behavior amongst both groups. The Herzberg Theory on hygiene and motivation served as a reference guide for the identification and classification of these factors as well as proposed solutions by the groups of participants. This theoretical model defines the interpretation of dissatisfaction and guides the directors in decision-making and implementation of solutions. Results showed that the food services personnel were more concerned about hygiene whereas the health care noticed dissatisfaction related to motivational factors. Thanks to the application of this model the food service personnel who were experiencing difficulty with hygiene matters saw modifications in their environment and health care employees enjoyed improvements in their tasks.

The referral nurse represents the care environment, he/she is the guarantor of the care plan and forms a commitment with regard to the patient. This positioning, arising from the empathy he/she has for the patient in a situation of vulnerability, may lead him/her to object to and question a medical decision.

The objective of this study was to describe the experience of caring for individuals at the end of life by five nurses working in curative care units. Semi-structured interviews were conducted to gain a better understanding of the meaning nurses give to this experience. The analysis of results, based on Giorgi's phenomenological method (1997), highlighted a central meaning: it is a human experience fraught with paradoxes where the bedside nurse feels both privileged to be accompanying these individuals at the end of their lives and torn between the medical priority given to curative care and the lesser priority given to palliative care. This study offers relevant options for nurse managers wanting to improve these nurses' work environment and the quality of care for individuals at the end of life.

The authors investigated the understanding of emotion dissimulation in school-age children. Sixty participants were read short stories in which a main character expressed an emotion or hid an emotion from other characters. The participants were asked to identify the emotion felt by the main characters and to indicate the facial expressions they would display. Then they were asked what emotions the main characters felt while they were displaying these expressions, and what the beliefs of the other story characters would be as to the emotion felt by the main characters. The results revealed that children from 5 to 6 years of age have a partial understanding of emotion dissimulation. They were accurate in finding the emotion felt by the main characters when questioned the first time. They were also accurate in choosing the expressions the main characters would display to hide their emotions. However, they were often inaccurate as to the felt emotions of the main characters when questioned the second time. Compared with 9- and 10-year-olds, the younger children had more difficulty understanding the simultaneous character of felt and displayed emotions. Five- and 6-year-olds were also less accurate than the older children when asked to indicate the beliefs of the other characters in stories where felt emotions were hidden.

This communication distinguishes interdisciplinary problems from other neighbouring difficulties, such as difficulties related to work organization. The conceptual proximity between discipline and profession can in fact cause difficulties experienced in the interprofessionnal space to mistakenly incriminate interdisciplinarity. For the analyst, this proximity blurs his insight and, in effect, inhibits the development of adequate solutions to the encountered problem. Hence, this article, based on an ethnographic study of interdisciplinary relations in a small long-term care hospital, aims to alleviate the ambiguity surrounding this issue. In order to do so, this article will begin by recalling the parameters of the theoretical field of interdisciplinarity. Subsequently, the difficulties observed in the long-term care hospital's setting, as they were conceived in the light of interdisciplinarity theory, will be exposed. This article will notably highlight how the nursing staffs contribute to the maintenance of a philosophy of care favourable to the long term deployment of interdisciplinarity.

We report the case of a 15-year old girl presenting with a gastric fullness sensation. The biological examination showed iron deficiency anaemia and elevation of the pancreatic enzymes. At endoscopy, a huge trichobezoar is found in the stomach. The endoscopic removal is impossible due to the compacity of the mass. Surgical resection is therefore performed. The postoperative course is uneventful and the biologic anomalies are rapidly corrected. A throughout anamnesis revealed a trichotillomania with trichophagia, this behavioural trouble found its origin in a familial conflict.

The training of the primary care physicians has been neglected for long by the French medical faculties that, since 1958, favoured the hyper-specialization of their students. The initiative of a few primary care physicians supported by some academic internal medicine physicians allowed changing this situation gradually. Commitment of a training period in primary care practice and then the involvement of teaching general medicine physicians in the course of the theoretical training were essential to this shift. Following three decades of reforms that lead to recognize general medicine as a sub-specialty, an acknowledged academic course of general medicine is eagerly expected for 2009 with the first appointments of professors of general medicine with tenure. The general internists who share the same objective of global patient care are determined to support this academic course that they will welcome within the French National Council of Universities. This academic course will have to comply with the same teaching and research requirements than the other medical subspecialties.

The examination of a person's genetic characteristics is not a classic diagnostic. It concerns the gene pool of an entire family. It is valid in the present and may affect some part of the future. The diseases that it reveals, sometime very serious ones, may or may not be treated. But genetic advice allows sometimes to preventing some of these diseases. The 2004 Bioethics Law makes the provision that in case a serious genetic anomaly is diagnosed during the examination of a person's genetic characteristics, the medical doctor informs the person or its legal representative of the risks that his silence could cause to the potentially concerned family members as long as prevention measures or care can be offered to them. For these reasons, besides the specificity of the diagnostic for the person directly concerned, there is also the question of the right of other people, like family members, to be informed of the diagnostic. As such, there is an ethical conflict between medical confidentiality owed to each patient and the duty of information. The pharmacist must know the medical confidentiality rules that frame this information. He must also know the different patient attitudes and must be able to encourage him to inform his family because the future if not the life of others may depend on this information.

This study explores the influence of typical size during a categorization task. The specificity of this experimental work is based on the homogeneity of the graphic stimuli size. We have created a typical size standard of our stimuli, that concerns the real size of the objects represented by the drawings of homogeneous sizes. Then, a priming experiment was performed in which the prime and target drawings had two types of relations: a typical size, and a categorial. The participants are naïve as to the typical size relation between prime and target. The results show a positive priming effect of the typical size but not of the category. The results are discussed in term of theoretical approach developed by Barsalou and his colleagues (1999, 2003). In this theoretical framework, the typical size can be considered as a perceptual knowledge. In that way, we propose that participants could automatically simulate the typical size as soon as they perceived the drawings of objects with homegenous sizes.