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En France, en moyenne 40 % des personnes condamnées sont en état de récidive ou de réitération. Afin d'éviter les ruptures de soins susceptibles de conduire à la commission d'une nouvelle infraction, le service médicopsychologique régional de la maison d'arrêt a d'abord développé, en 2021, l'accompagnement post-carcéral de courte durée (six mois). L'équipe pluridisciplinaire ambitionne désormais de favoriser l'entrée dans un processus de désistance des hommes suivis en prison, et accompagnés à la sortie. La stratégie arrêtée pour tenter de répondre à cette nouvelle mission comprend trois volets : formation, organisation, et développement de l'offre de soin. L'équipe a commencé à se former à trois outils : HCR20 V3, SAPROF et CAPP. Le premier intéresse l'évaluation et la gestion du risque de récidive violente interpersonnelle, le second le repérage des facteurs de protection liés à la violence, et le dernier concerne le trouble de personnalité psychopathique, facteur prépondérant de risque de violence. Sur le plan de l'organisation, les soins au SMPR ont été repensés pour intégrer l'évaluation du niveau de risque de récidive en détention, et sa réévaluation en cours d'APC. Le but est maintenant d'agir stratégiquement sur d'éventuels facteurs de risque dynamiques repérés, en tenant compte des facteurs de protection. Le développement de l'offre de soin, entrepris en 2022, a abouti en octobre 2023 à l'ouverture d'une unité de colocation thérapeutique et d'insertion (UCTI), dispositif « passerelle » pouvant accueillir cinq hommes sortants, accompagnés en post-carcéral par le SMPR, pour six mois également. L'objectif principal de cette étude observationnelle, prospective et monocentrique, est de mesurer l'efficacité du suivi intra-carcéral et de l'accompagnement post-carcéral – restructurés autour d'outils d'évaluation et de gestion du risque de récidive – des personnes sortantes de MA d'Amiens, sur la désistance à l'issue de l'APC et à cinq ans. Cette efficacité pourrait se traduire, pour les personnes accompagnées en post-carcéral, par une diminution de l'expression des traits psychopathiques et du niveau de risque de récidive entre le moment de l'incarcération et la fin de la prise en soin. Les professionnels souhaitent également documenter la mise en place des trois outils dans leur service, et en étudier la validité prédictive sur leur échantillon. L'étude sert aussi à évaluer l'efficacité du dispositif expérimental UCTI. Le repérage précoce des facteurs de risque devrait permettre d'améliorer la spécificité et la priorisation des actions de prévention du risque entrant dans le cadre des soins courants. Démonstration faite de l'efficacité de ces soins, enrichis par l'emploi d'outils adaptés à la problématique de la population carcérale sortante, il serait envisageable de répliquer cette stratégie de spécialisation psychiatrique pénitentiaire dans les équipes psychiatriques exerçant dans d'autres établissements pénitentiaires. Le projet s'inscrit dans une volonté de décloisonnement des différents secteurs concernés par la prise en charge des personnes sortantes. Le travail collaboratif en équipe pluridisciplinaire, au sein du service mais aussi avec les dispositifs de droit commun, est au cœur des retombées de cette recherche. Serait-il possible de revitaliser l'engagement individuel et collectif de ceux qui agissent auprès de patients qui peuvent présenter un risque de violence ? In France, an average of 40% of convicted prisoners are repeat offenders. To prevent disruptions in care that may lead to new offenses, the regional medico-psychological department (SMPR) of the Amiens prison first introduced short-term post-incarceration support (6 months) in 2021. The multidisciplinary team now intends to facilitate the transition to a desistance process for incarcerated men who are undergoing treatment in prison and to, provide support when they are released. The strategy consists of three main components: training, organization, and expanding the range of care. The team has already started training for three tools: HCR20 V3, SAPROF, and CAPP-IRS. The first pertains to the assessment and management of the risk of interpersonal violent relapse, the second focuses on identifying protective factors related to violence, and the third addresses psychopathy, a significant risk factor for violence. In terms of organization, care at the SMPR has been restructured to incorporate the assessment of the level of risk of relapse during detention and its reassessment during post-carceral follow-up. The aim now is to strategically address any identified dynamic risk factors, taking protective factors into account. The expansion of the care provided, begun in 2022, led to the opening of a therapeutic and integration cohabitation unit (TICU) in October 2023, serving as a "gateway" facility accommodating 5 men who have been released from custody supported by the SMPR in post-carceral care, also for a duration of 6 months. The primary objective of this observational, prospective, and single-center study is to measure the effectiveness of intra-carceral and post-carceral support – restructured around risk assessment and management tools – for individuals exiting the Amiens prison after achieving desistance at the end of the follow-up and for a period of 5 years. This effectiveness could be reflected in a reduction in psychopathic traits and in the level of risk of recidivism for those supported in post-carceral care, from the time of incarceration to the end of care. These mental health care professionals also wish to document the implementation of the three tools in their service and assess their predictive validity within their sample. The study also serves to evaluate the effectiveness of the experimental TICU program. The early identification of risk factors should improve the specificity and prioritization of risk prevention actions as part of routine care. Demonstrating the effectiveness of this extended treatment program, tailored to the needs of the outgoing incarcerated population, could lead to the replication of this specialized psychiatric approach in other penal facilities. The project is part of a common effort to break down barriers between the various sectors involved in the care of individuals who are released from prison. Collaborative multidisciplinary teamwork, both within the department and with mainstream psychiatric care facilities, lies at the core of the results of this research. Could it be possible to revitalize the individual and collective commitment of those working with patients who may present a risk of violence? [ABSTRACT FROM AUTHOR]

Les violences entre partenaires intimes (VPI) constituent un problème de santé publique. Bien plus qu'un simple conflit dans le couple, il s'agit d'un processus de prise de pouvoir d'un partenaire sur l'autre, par le recours à la violence (physique, psychologique, sexuelle et/ou financière). Les recommandations internationales pour la prise en charge des auteurs de VPI insistent sur la nécessité de mettre en place des processus d'évaluation précoces de la récidive afin de prévenir la violence et d'orienter l'action judiciaire et les programmes de prise en charge. Parmi les échelles de jugement clinique structuré développées pour l'évaluation des VPI, la Spousal Assault Risk Assessment (SARA-V3) est l'outil le plus largement employé. Le présent article présente une étude en cours de développement dont l'objectif est de traduire et de valider la SARA-V3 en version française. La première partie de l'étude consiste à administrer la SARA-V3 auprès d'auteurs suspectés ou condamnés de VPI pour permettre de mesurer les qualités psychométriques de la traduction française. Dans la seconde partie, une étude qualitative vise à évaluer la perception des professionnels de terrain quant aux échelles d'évaluation du risque (et particulièrement de la SARA-V3). Intimate partner violence (IPV) is an international public health problem. Much more than a simple conflict within a couple, it's a process of one partner taking power over the other, through the use of violence (physical, psychological, sexual and/or financial). IPV is rarely an isolated act and generally follows a pattern of chronic abuse. The risks of re-victimization in this context are significantly higher than in other criminal victimization contexts. International recommendations for the management of IPV offenders emphasize the need to establish early assessment processes for recidivism, to prevent violence and guide judicial action and management programs for IPV offenders. Among the structured clinical judgment scales developed for the assessment of IPV, the Spousal Assault Risk Assessment (SARA-V3) is the most widely used tool. While there are several scales for assessing the risk of IPV recidivism, research into their psychometric qualities remains limited, especially for the French-language versions. In addition to the availability of assessment tools, several problems have been identified in the use of IPV recidivism risk assessment instruments by practitioners in real-life situations: frequent recourse to unstructured professional judgment, problems in complying with recommendations for administering assessment instruments, and a lack of training. This article presents a study currently under development whose aim is to translate and validate the SARA-V3 in French. The first part of the study consists of administering the SARA-V3 to suspected or convicted perpetrators of IPV, to measure the psychometric qualities of the French translation. To carry out the assessment of IPV situations, we propose collecting data at several stages in the judicial process. The total sample will be made up of men suspected or convicted of IPV. They will be evaluated in various organizations that deal with perpetrators of IPV and at different stages of the judicial process, namely: in a police department, with expert psychiatrists, and in specific therapeutic care services. After receiving a favorable opinion from the Ethics Committee of the UMONS Faculty of Psychology and Educational Sciences, the SARA-V3 scale was translated into French with the support of the English Unit: Literature, Language, Interpretation and Translation (ELLIT) department of the UMONS Faculty of Translation and Interpretation. The second part of the study analyzes the perceptions of professionals in the field regarding risk assessment scales (particularly SARA-V3). This second stage of the research examines the professionals' perceptions of the benefits of JPS. The participants in this study are those psychologists who contributed to the first part of the study. They are interviewed in a semi-structured interview. The aim is to evaluate the use of SARA-V3 in a clinical context, its scoring mechanics, validity, training, and perspectives. [ABSTRACT FROM AUTHOR]

Les enquêtes de santé conduites récemment auprès de populations d'adolescents et de jeunes adultes ont mis en lumière des taux alarmants d'idées suicidaires. Un défi important que doit relever tout clinicien face à un patient suicidaire est l'évaluation du risque de passage à l'acte et la prise en charge thérapeutique des pensées et des conduites en lien avec le suicide. Dans ce contexte, la mise en évidence récente chez ces patients d'images mentales intrusives extrêmement fréquentes et vivaces en lien avec le suicide, les flashforwards suicidaires, pourrait ouvrir la voie à d'importantes avancées dans notre capacité à évaluer et aider les patients en prise avec une problématique suicidaire. C'est ce sujet qu'évoque Arnaud Pictet dans cet entretien avec Jean-Pierre Bouchard. Recent surveys have shown an alarming increase in suicidal behaviours in adolescents and young adults, a population known to be associated with high levels of stress, anxiety, and depression. Despite the great improvements made over the years in the way we understand and address suicidality in the clinic, it remains extremely challenging and complex for the clinicians to assess risk and help patients alleviate their suicidal thoughts. In this context, recent studies have shown that a particular form of intrusive mental imagery of suicide, called "flashforwards" in analogy with the flashbacks in PTSD, could play a pivotal role in suicidal behaviour. More specifically, suicidal flashforwards have been shown to be associated with greater severity of suicidal symptoms and a greater likelihood of engaging in actual suicidal behaviour. This in line with the broader evidence of a powerful impact of mental imagery on emotion and behaviour, while in the specific of context of suicidality these flashforwards could be seen as real marker of suicidal risk and severity. Frequent exposure to suicidal scenarios through repeated experience of intrusive imagery may induce habituation to this outcome and thus increase the person's acquired ability to do so. Beyond assessment of suicidal risk, exploring suicidal images offers privileged access to the emotional states, cognitions, and behavioural responses that patients experience when they feel at their most depressed and despairing. Further, recently developed intervention methods designed to specifically target these suicidal images could hold promise in helping patients to deal with their suicidality. These are the subjects that Arnaud Pictet evokes in this interview with Jean-Pierre Bouchard. [ABSTRACT FROM AUTHOR]

En France, l'évaluation structurée du risque de récidive est peu développée face au jugement professionnel non structuré, pourtant moins valide. Cet article propose une revue systématique de la littérature, répondant aux critères PRISMA, sur la perception et la pratique de l'évaluation structurée, en France, chez les professionnels concernés. Les mots clés « Évaluation du risque » AND « récidive » AND « France » ont été recherchés dans Pubmed, PsycInfo, Cairn et ScienceDirect. Les 23 articles obtenus dans les résultats montraient des craintes et peu d'avantages concernant l'évaluation structurée, la possibilité d'un système hybride et les quelques travaux français utilisant des échelles de risque. Ces réticences concernaient : (i) le système judicaire français (notamment le tout actuariel) ; (ii) les professionnels évaluateurs (confusion des rôles entre professionnels) ; (iii) les personnes évaluées (risque de stigmatisation des infracteurs à haut risque) ; et (iv) les outils eux-mêmes (prédictivité modérée). La validité scientifique, clinique et les garanties éthiques des échelles structurées du risque sont pourtant suffisantes pour permettre leur développement en France. Quelques hypothèses sont avancées pour expliquer les réticences à leur généralisation en France. In France, the recidivism of offenders (both sexual and non-sexual violence) is a national concern as evidenced by the media and the succession of laws relating to the prevention of recidivism. Risk assessment can be performed using unstructured professional judgment which is unreliable or by structured risk assessment which are more reliable. Abroad, this structured assessment is considerably developed. In France, it gives rise to two opposing positions: (i) encouragement by public authorities; and (ii) fear by a majority of professionals in the field. This article offers a systematic literature review, meeting PRISMA criteria, on the perception and practice of standardized evaluation in France by the professionals concerned. The keywords "Risk assessment" AND "recurrence" AND "France" were searched in French and in English in the search engines Pubmed, PsycInfo, Cairn, and ScienceDirect. The 23 articles obtained in the results highlighted: (a) fears and few advantages regarding the use of structured evaluation; (b) a possibility of a hybrid evaluation system in France; and (c) a report of some works already using scales of risk on French populations. This article focused mainly on the fears and perceived benefits of structured risk assessment. The reluctance has concerned both: (i) the French judicial system (fear of a new penology based only on the actuarial approach and its consequences); (ii) the professional valuers (fear of a confusion of professional's roles in health and justice fields); (iii) the persons assessed (fear of a risk of stigmatization of high-risk patients concerning violence); and (iv) the tools themselves (fear of a poor reliability of the risk assessment). Very few articles highlighted their advantages: reliability, simplicity of use, good inter-judge fidelity, guideline for care, and specially an ability to overcom the insufficient basis for the evaluation resulting from unstructured clinical judgment. Results also suggested the possibility of a hybrid evaluation system in France, which could rely on risk scales, without neglecting the interview and the qualitative collected information that have to respect precise steps and allow the management of offenders. Finally, this paper presented the few French studies using risk scales mainly focused both in sexual offenders' risks and associated factors, and showing a better productivity of these scales than an unstructured professional judgment. Fears related to the structured risk assessments are important. However, these scales may also supply a better vision of offenders. They require skills of professionals from various fields and allow both a fairer assessment of the offender and a penal system more adjusted. This perceived reluctance seems to be due to a poor knowledge of structured assessment the risk scales and a lack of research studies using them in France, where it is necessary to have a broad reflection on their development in the future. [ABSTRACT FROM AUTHOR]

Résumé La propagation rapide des produits agro-biotechnologiques a suscité beaucoup de controverses au sujet des avantages, des risques et des limites des plantes transgéniques. Les effets néfastes des plantes génétiquement modifiées (GM) qui peuvent être ingérées peuvent provoquer des effets toxiques ou l’induction de réponses immunitaires indésirables, telles qu’une activité de modulation allergique ou immunitaire. L’évaluation de l’allergénicité est une étape dans l’évaluation de la biosécurité des aliments dérivés de cultures GM. Cet article de revue se concentre sur un sujet d’intérêt courant, l’analyse du potentiel allergénique des aliments dérivés de cultures génétiquement modifiées, des stratégies d’évaluation institutionnelle, des techniques protéomiques pour l’identification de protéines transgéniques ayant des propriétés allergéniques. Des études récentes montrent l’impact des cultures transgéniques du blé (albumine/globuline et gluten) sur l’asthme et l’allergie alimentaire IgE dépendante. Par conséquent, une analyse complète des allergènes (allergénomique) est très importante pour l’évaluation des risques non seulement des plantes alimentaires, mais aussi pour le diagnostic des symptômes allergiques. The rapid spread of agro-biotechnological products has aroused a lot of controversy about the benefits, risks and limits of transgenic plants. The harmful effects of edible genetically modified plants can include toxicity or the induction of unwanted immune responses such as an allergic or immune modulation activity. The evaluation of allergenicity is a step in the assessment of the biosecurity of food derived from GM crops. This review article focuses on a topic of current interest: analysis of the allergenic potential of foods derived from genetically modified crops, of institutional assessment strategies, and of techniques for identification of transgenic proteins having allergenic properties. Recent studies show the results in terms of the extent to which transgenic wheat crops (albumin/globulin and the gluten protein) are responsible for asthma and IgE food allergy. Thus, a comprehensive analysis of allergens (allergenomics) is essential not only for assessment of the risks of food plants, but also for the diagnosis of allergic symptoms. [ABSTRACT FROM AUTHOR]

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Résumé Introduction Les instruments d’évaluation du risque et des besoins de la famille LS ( level of service ) sont parmi les plus utilisés auprès des populations délinquantes dans le monde anglo-saxon. Jusqu’à présent, il n’existait pas de version validée en français du plus récent et plus complet de ces instruments, l’inventaire de niveau de service et de gestion des cas (LS/CMI ; Andrews, Bonta, & Wormith, 2004). Objectifs Cet article présente les propriétés psychométriques de la version française du LS/CMI utilisée auprès de personnes placées sous main de justice condamnées à une peine correctionnelle de moins de deux ans au Canada. Méthode Au total, 3682 personnes placées sous main de justice, soit 301 femmes (8,2 %) et 3381 hommes (91,8 %), ont été évaluées dans le cadre de la présente étude. L’analyse des propriétés psychométriques révèle que les épreuves de fidélité (cohérence interne), l’analyse factorielle exploratoire et la validité prédictive de la version française sont bonnes, très comparables à la version originale. Résultats Les résultats des analyses effectuées confirment la pertinence du LS/CMI pour prédire les nouvelles arrestations et les nouvelles condamnations pour des infractions violentes et non violentes. Le LS/CMI permet aussi de prédire de la même façon les manquements aux conditions de surveillance. Conclusions La version française du LS/CMI permet donc de prédire la récidive chez une grande variété de personnes et de structurer l’intervention correctionnelle de manière cohérente. Introduction Instruments of the LS family are among the world's most widely used risk assessment instruments. Objective This study is testing the psychometric properties of the French version of the Level of Service/Case Management Inventory (LS/CMI; Andrews, Bonta, & Wormith, 2004). Method Reliability and predictive validity of the scales, as well as the total scale are tested on a sample of 3682 offenders (301 women and 3381 men) serving a sentence of less than two years. Results Results indicate psychometric properties consistent with the English version. Internal consistency, exploratory factor analysis, and predictive validity are good. Conclusion The current French version of the LS/CMI is a reliable and valid instrument to assess risk for recidivism, and is a solid foundation to support correctional treatment implementation. [ABSTRACT FROM AUTHOR]

Résumé But L’interprétation de l’albuminémie (ALB) pouvant être influencée par l’administration d’albumine, la valeur prédictive de ALB sur la mortalité en soins intensifs pourrait différer avant (période PRE) et après (période POST) l’entrée en vigueur de restrictions de l’utilisation de solutions d’albumine (juillet 2012). Patients et méthodes Les données démographiques, anthropométriques, cliniques et thérapeutiques, y compris l’utilisation de solutions d’albumine ont été enregistrées à partir d’une cohorte d’admissions successives dans le service des soins intensifs de l’hôpital Erasme, pour une durée d’au moins 3 jours. La valeur prédictive de ALB pour la mortalité a été comparée entre les périodes PRE et POST. Résultats Les données démographiques, anthropométriques et cliniques des deux groupes (PRE, n = 118 et POST, n = 104) étaient comparables à l’admission. Une proportion plus importante de patients a reçu de l’albumine lors de la période PRE (14,4 %) que POST (2,9 %, p < 0,01). Dans le groupe PRE, la valeur moyenne d’ALB est restée stable durant les 3 premiers jours (de 3,0 ± 0,8 à 3,0 ± 1,8 g/dL), alors qu’elle a diminué dans le groupe POST (de 3,1 ± 0,9 à 2,7 ± 0,8 g/dL, p < 0,05). La valeur prédictive de ALB pour la mortalité était plus basse lors de la période PRE (0,52 [IC 95 % 0,38–0,66]) que lors de la période POST (0,60 [IC 95 % 0,47–0,73], p < 0,05). Conclusion La valeur prédictive de ALB pour la mortalité est faible et encore diminuée lors de la perfusion de solutions d’albumine. Les scores de sévérité ou d’évaluation nutritionnelle utilisant ALB devraient être ajustés pour cette donnée thérapeutique. Objective As the assessment of nutritional status using plasma albumin level (ALB) can be confounded by the infusion of albumin solutions, the predictive value of ALB on the mortality rate in the intensive care unit (ICU) may vary before (period PRE) and after (period POST) a restriction of the use of albumin solutions (July 2012). Material and methods Demographic, anthropometric, clinical and therapeutic data, including the proportion of patients who received albumin were recorded from consecutive patients who stayed at least 3 days in the medico-surgical ICU of the Erasme university hospital. The predictive value of mean ALB was compared between the two periods. Results The two groups (PRE [ n = 118] and POST [ n = 104]) were similar for age, gender, severity of illness and BMI. A significantly higher proportion of patients were treated with albumin in the group PRE (14.4%) than in the group POST (2.9%, P < 0.01). The mean ALB value was stable over the first 3 days in the PRE group (from 3.0 ± 0.8 to 3.0 ± 1.8 g/dL) but decreased in the POST group (from 3.1 ± 0.9 to 2.7 ± 0.8 g/dL, P < 0.05). The predictive value of ALB for mortality was lower in the group PRE (0.52, 95% confidence interval [CI] 0.38–0.66) than in the group POST (0.60, 95% CI 0.47–0.73, P < 0.05). Conclusion The predictive value for mortality in the ICU of ALB is low, and the infusion of albumin further decreases this value. Severity scores or nutritional assessment using ALB should be adjusted for the infusion of albumin. [ABSTRACT FROM AUTHOR]

Résumé Alors que la prévention de la récidive est en train de subir nombre de transformations en France, l’évaluation du risque de récidive des personnes placées sous main de justice constitue un enjeu majeur. L’absence de structuration et de standardisation des évaluations soulève des doutes à propos de leur validité et souligne la nécessité de recourir à des méthodes d’évaluation cliniquement et scientifiquement validées. Les professionnels et leurs administrations bénéficient désormais d’un éventail de stratégies pour effectuer une évaluation la plus juste, la plus transparente et la plus cohérente possible. Cet article retrace l’évolution de l’évaluation du risque de récidive, les principales stratégies et méthodes, les familles de facteurs de risque les plus couramment utilisés, en plus d’illustrer deux stratégies d’évaluation typiques dans le champ de l’évaluation du risque récidive, l’évaluation intégrée à l’aide du LS/CMI et l’évaluation basée sur le jugement professionnel structuré à l’aide de la HCR-20. Although the prevention of recidivism in France is currently undergoing numerous transformations, the evaluation of the risk of recidivism of individuals under the justice system is a major issue. The absence of structure and standardization in current evaluation procedures raises doubts regarding their validity and underlines the necessity to determine evaluation methods that are clinically and scientifically validated. The professionals and their administration would benefit largely from a range of strategies that would aid in executing the most just, transparent and coherent evaluation possible. This article will trace the evolution of the evaluation of the risk of recidivism, the principal strategies and methods, the most common risk factor families used, as well as illustrations of two typical strategies of evolution of the risk of recidivism; integrated evaluation with the LS/CMI and evaluation based on structured professional judgment guided by the HCR-20. [ABSTRACT FROM AUTHOR]

Résumé Les résultats des différents travaux sur les pratiques probantes visant la prévention de la récidive sont clairs : il est possible de réduire le risque de récidive des personnes placées sous main de justice par une intervention efficace. L’évaluation structurée du risque de récidive, combinée à des pratiques basées sur les principes du risque, des besoins et de la réceptivité (R-B-R) permettent de réduire ce risque de près de 30 %. Ces programmes, développés principalement au Canada, nécessitent toutefois de faire l’objet d’une adaptation au contexte français. Le présent article propose de passer en revue les principales étapes cruciales à la mise en place d’une nouvelle stratégie d’évaluation et d’intervention basée sur les données probantes, à savoir l’exploration, la préparation de la mise en œuvre, la formation et l’implantation proprement dite, la démarche de pérennisation et la mise en place de travaux de recherche évaluative. Les avantages de considérer une telle stratégie d’implantation sont discutés. The results of different studies on the best practices of the prevention of recidivism are clear: it is possible to reduce the risk of recidivism of offenders through efficient intervention. Structured risk assessment combined with practices based on risk, need and responsivity principals may reduce the risk of recidivism by up to 30%. These programs, developed primarily in Canada, require adaptations to better suit a French context. The present article proposes to revise the main stages essential to the introduction of a new evaluation and intervention strategy based on evidence, namely, the exploration, the preparation of the establishment, the creation and implementation themselves, the sustainability approach and the introduction of evaluative research studies. The advantages of considering such an implementation strategy are discussed. [ABSTRACT FROM AUTHOR]

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Abstract: Introduction: An evaluation of predictive risk factors for pressure ulcers is essential in development of a preventive strategy on admission to hospitals and/or nursing homes. Objectives: Identification of the predictive factors for pressure ulcers as of 2012. Method: Systematic review of the literature querying the databases PASCAL Biomed, Cochrane Library and PubMed from 2000 through 2010. Results: Immobility should be considered as a predictive risk factor for pressure ulcers (grade B). Undernutrition/malnutrition may also be a predictive risk factor for pressure ulcers (grade C). Discussion: Even if the level of evidence is low, once these risk factors have been detected, management is essential. Sensitizing and mobilizing health care teams requires training in ways of tracking and screening. According to the experts, risk scales should be used. As decision aids, they should always be balanced and complemented by the clinical judgment of the treatment team. Conclusion: According to experts, it is important to know and predictively evaluate risk of pressure ulcers at the time of hospital admission. The predictive risk factors found in this study are identical to those highlighted at the 2001 consensus conference of which was PERSE was the promoter. [Copyright &y& Elsevier]

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Abstract: Critical analysis of the psychiatric reports of psychotic criminals attached by order to hospitals demonstrates the partial responsibility of these patients (second paragraph of Article 122-1 of the French Penal Code), whereas there is a direct ascertained relation between their mental disorders and their homicidal acts. The current tendency to sentence psychotic patients has led to their increasing numbers in prisons, where they pose serious problems of management and discipline. The author recalls that « madness » can be « lucid », that psychotic individuals do not lose all contact with reality, that they are capable of dissimulating their disorders and that they can sometimes premeditate their criminal acts. Even so, they are not really conscious of the pathological nature of their behavior. Furthermore, their responsibility is legally not involved since there is no moral element to their criminal acts. Psychiatrists and psychologists should change their archaic practices and use the modern actuarial methods of diagnostic and prognostic assessment. Delinquent individuals suffering from severe mental disorders should not be sentenced and imprisoned. Rather, they should receive medical treatment and be under conditions and supervision. [Copyright &y& Elsevier]

Abstract: Detention for reasons of public safety, an exceptional measure created by the French law of February 25, 2008, concerns individuals sentenced for certain major crimes who have a serious personality disorder and who present a very high risk of re-offending after their release. This measure involves placing the individual in a special socio-medicolegal center after the sentence has been served. The system raises several forensic issues: was it necessary, considering the already numerous repressive measures available in France? What can be considered as a serious personality disorder? How is the supposed considerable dangerousness of the individual to be evaluated? In their critique of the increasing complexity of the French system of repression, the authors propose a unique law on the safeguarding of society and social rehabilitation, which involves periodic scientific assessment of criminal dangerousness: before sentencing, during the detention, before the criminal''s release and, if necessary, in the community. The new regulations concerning the declaration of criminal irresponsibility for mental disorder provide little progress except for the possibility for certain judges to order forensic placement of criminals as well as conditions (prohibitions and obligations) concerning them after their confinement in a psychiatric establishment. Finally, the recent procedures of the February 25, 2008 law continue to refer to the practice of the legal psychiatric report, whereas this method no longer meets the requirements of the modern scientific practice of criminology and is incapable of correctly assessing serious criminal behaviour. [Copyright &y& Elsevier]

Abstract: In order to assess the internal structure of risk assessment of sexual recidivism of the Sex Offender Risk Appraisal Guide (SORAG), and the STATIC-99, a principal components analysis followed by promax rotation was conducted. In a data set including adults forensic sex offenders, three interpretable components were identified both with the SORAG (n =79) and the STATIC-99 (n =254): “past criminal behaviour”, “demographic characteristics”, and “antisocial personality” for the SORAG and “criminal past behaviour”, “aggressor-victim relationship” and “sexual offence” for the STATIC-99. Prospective data were available (SORAG: n =133; STATIC-99: n =137). For both instruments, the “criminal past behaviour” factor was the only one predicting general recidivism, violent recidivism and sexual recidivism. [Copyright &y& Elsevier]

Abstract: This article describes the lawful bases of the reprotoxic risk management in work environment, and sets out the recommendations of the French Société de Médecine du Travail (occupational medicine) for the medical supervision of pregnant wage-earners exposed to toxic substances as far as foetal development is concerned. We start with the description of the lawful bases, clarifying the various types of classification of toxic substances for reproduction, the particular regulation applying to reprotoxic categories 1 and 2, particularly with regard to the labelling of these products, the prohibition of availability to the general public, the principles of prevention and the guarantees of remuneration of the pregnant women exposed to this risk. Then, we present the recommendations worked out by the Société Française de Médecine du Travail, with regard to the medical supervision of pregnant wage-earners. They include: evaluation of the risk on the work place, evaluation of exposure, be it external or internal, presentation of methods of calculation of values guides and of recommendations transmitted to occupational doctors, before and during the pregnancy of their patients. To conclude, it is important to remain rigorous with this reprotoxic risk, by referring to the lawful bases at our disposal and supporting the scientific bases following epidemiologic studies. Adequate information must be given to women but also men pf procreation age. In spite of a well-defined lawful framework, watchfulness is required with the new products put on the market and the new scientific data. [Copyright &y& Elsevier]

Abstract: Assessing dangerousness among persons with a mental illness is an old and complex clinical issue. In accordance with scientific literature, it is based upon a rigorous and systematic analysis of risk factors for violence. It also requires good relational abilities from the clinician, as well as a level-headed judgment at the term of the evaluation. Moreover, the practice of dangerousness estimation represents the first step of the therapeutic process and the establishment of a bond with the patient. [Copyright &y& Elsevier]

Abstract: This paper reviews the present views and methods in the field of violence risk assessment. The perpetration of violent behaviours must raise the issue of the perpetrator''s psychological constitution and functioning. But being able to anticipate such dangerous deeds implies other dimensions as well: one must also consider contextual elements, “countertransferential” feelings elicited by the perpetrator in relevant individuals, and potential outcomes of the evaluation that is carried out. Nowadays, this is performed by means of so-called “Violence Risk Assessments”, using various instruments. Actuarial instruments are designed to provide a statistical estimate of future violence risk, while (semi-structured) clinical methods assist clinical professional decision-making with guidelines developed according to up-to-date knowledge in the field. The key concept of psychopathy, its measurement and implications, are also discussed, and valuable indicators are recommended, to be used both for violence risk management as well as for the development of a clinical framework on this topic. [Copyright &y& Elsevier]