Search

In France, many social representations refer to gifted children who describe them as hypersensitive, curious, and creative. Although sometimes inaccurate, these representations can be conveyed in media intended for children and contribute to an erroneous transmission of characteristics of children with particularities. The objective of this study was to identify the social representations of gifted characters in French children's literature. For this, we used a coding grid to analyze a corpus of 23 French books. The grid was designed based in the emotional and creative characteristics and their associated behaviors. Results showed that the representations of the gifted characters in the books studied were stereotypical, particularly in terms of their emotional characteristics. Applications and perspectives for future studies are discussed.

Many international organizations have called on governments to make inclusive schooling for children with disabilities a priority. Although the number of children with disabilities enrolled in France's mainstream schools has doubled over the last 15 years, inclusion rates vary according to type of disability and educational stage. Another important parameter is the efficacy of inclusive schooling, which may depend on teachers' attitudes toward working with students with disabilities. In the present study, we used measures of 440 in-service teachers' and 135 pre-service teachers' attitudes toward inclusive education to investigate possible links between these attitudes and three variables: teacher status (pre-service vs. in-service), educational stage, and type of disability. Participants completed the Multidimensional Attitudes Toward Inclusive Education Scale between January and April 2021, giving responses with respect to inclusive education in general and to five categories of disabilities. In-service and pre-service teachers had similar attitudes toward inclusive education in general, but pre-service teachers had significantly more positive attitudes than in-service teachers toward students with cognitive disabilities, sensory disabilities, and motor disabilities. Our findings suggest ways for promoting the inclusion and well-being at school of both non-typically developing and typically developing children.

Many educators in immersion contexts support a policy of strict separation of languages in the classroom as the ideal model for second language acquisition and are reluctant to make connections between the dominant language, the target language and pupils' home languages. This can result in missed opportunities for drawing on pupils' entire linguistic repertoires to foster their learning The present study considers teachers' discourses surrounding the place and role of the dominant language (French), the target language (English) and home languages from the perspective of classroom teachers at one French primary school with a school-wide English immersion program participating in a collaborative research project. Since the program's inception in 2011, the one teacher/one language model has been adopted and approximately half the day is spent in each language. The analysis of the data comprising semi-structured interviews, filmed observations, stimulated video recall and focus group sessions revealed a shift in teachers' language awareness concerning the use of students' L1 as resources and their willingness to experiment with new pedagogies drawing on students' entire linguistic repertoires. The data highlighted challenges which emerged during the implementation of more flexible multilingual pedagogies as well as teachers' need for learning and long-term continued professional development.

Background: Life expectancy for people with Down syndrome is increasing, but older adults with Down syndrome are at greater risk of developing certain pathologies associated with ageing. When ageing parents can no longer look after their child with Down syndrome, their other children are often expected to shoulder this responsibility. Method: We asked 120 adult siblings of a person with Down syndrome to complete a questionnaire on their current and anticipated relationships. Results: Most respondents considered these relationships to be positive, but they expressed concerns about the effects of ageing and about having to organise their sibling with Down syndrome's future life. We investigated the impact of factors relating to the respondents and to their sibling with Down syndrome (age, gender, social inclusion, protection regime) on these general tendencies. Conclusion: Siblings need to be given support, for example, "via" discussion groups, to facilitate the transition to becoming caregivers.

Background: The increased life expectancy of people with Down syndrome puts pressure on parents, who are usually the main caregivers but who find caring more difficult as they get older. The quality of the support provided by brothers and sisters depends on the intra-family relationships they build when growing up. Methods: 121 adult siblings of people with Down syndrome completed a questionnaire on their perceptions of their childhood relationships. Results: Brothers' and sisters' relationships with a sibling with Down syndrome were mostly (very) positive, but this was not always the case for their relationships with their parents and other siblings. Factors affecting these relationships include respondent's sex, number of siblings, and sibling position. Conclusions: In addition to simple risk and protective factors, we identified parameters that should be taken into account when providing support to siblings and parents of people with Down syndrome.

The article examines the problems faced by a group of pre-service teacher students when they are asked to analyze an intercultural situation. We wondered whether the use of video could foster critical reflection which is so difficult to achieve when it comes to observing one's own value judgments. The following research question will be considered: would the use of video make it possible to observe an intercultural situation in teacher training? By intercultural we mean an approach that focuses on the processes of (re)actualization of plural identities in communication. The focus is less on culture as a determinant of ways of doing, speaking and being than on the way people use cultural traits to say/tell and judge each other in verbal and nonverbal communication. The article intends to open doors to new practices for intercultural education based on video annotation.

This research project is focused on theoretical and empirical works analyzing the effects of career counseling. This experimental and longitudinal study has been carried out in France; it compares a sample of individuals having undertaken competence assessment with a control group and deals with self-esteem, self-analysis, self-concept, and the participants' situations. The results correspond to the authors' main hypotheses: The effect size calculated for all the variables (+0.62) is similar to the one observed in the meta-analyses concerning the same topic. The stability of effects has also been demonstrated for 2 out of 3 categories of variables (effect size +0.44) in spite of a slight decrease in the production of self-concept. Finally, treatment intensity seems to have a lesser effect than the one expected, but it strengthens its role in the development of self-analysis. The discussion focuses on the prospects for counseling practice assessment, as well as theoretical directions meriting future development. (Contains 4 tables.)

Frailty would affect 4 out of 5 people aged of 85 and over in France. As part of a global project aimed to develop a multimodal system for the early detection of frailty among older adults living at home or in independent senior living apartments, we reported prospective quantitative study assessing a priori acceptability of this system based on Bel's integrative model devoted to the behavioral prediction use of an unknown technology. The platform is composed of 5 devices: a weight scale, a tensiometer, a wrist-worn step counter, an activity tracker and a tablet to exchange data with the aforementioned sensors over the internet. The inclusion criteria are: age 2: 80 years old, living at home or in independent senior living apartments, assessed as 'robust' or 'pre-frail'. The a priori acceptability is assessed through self-evaluation questionnaires, mainly using a continuous scale (min-max score 1-7). We included 34 volunteers (24 women and 10 men), mean age 85.6 years (± 4.1), 24 of whom were classified as 'robust' and 10 as 'pre-frail'. A priori utility of the multimodal system (mean score = 6.0 (± 0.9)), a priori intention of use (mean score = 5.9 (± 0.8)) and the rate of recommendation of the device before its first use (82.4% (± 17.4)) were clearly in favor of the device. This study is in favor of an a priori acceptability and an a priori intention to use rather favorable to the developing system. Those results point a need for significant ease of use and almost-perfect functioning of this connected system for good acceptability. • Poor prior experiences with NTIC don't alter the intention to use the ACCORDS system. • A priori acceptability and intention to use are rather favorable to the system. • Good acceptability seems to be conditioned by ease of use and near perfect functioning. [ABSTRACT FROM AUTHOR]

Copyright of Pouvoirs is the property of Editions du Seuil and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Societes Contemporaines is the property of Fondation Nationale des Sciences Politiques and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Politix is the property of De Boeck Universite and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Soft tissue sarcomas of the extremities (E-STS) are rare and heterogeneous. Treatment combines surgery with preoperative or postoperative radiotherapy (RT) for deep, large, or high-grade tumors. We evaluate the effectiveness and toxicity in E-STS patients treated at our institution from 2015 to 2021., Materials and Methods: This retrospective, single-center study, compared clinical and therapeutic characteristics, toxicities, and surgical complications by radiotherapy type. Local recurrence-free survival (LRFS), overall survival (OS), and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method., Results: We included 158 patients; 124 (78%) received preoperative RT. The two groups (preoperative RT vs. postoperative RT) differed significantly in terms of median tumor size (111 vs. 67.5 mm, p < 0.01), perivascular involvement (51% vs. 29%, p = 0.03), and bone contact (32% vs. 12%, p = 0.02), but not in grade (grade 2 or 3: 65% vs. 74%, p = 0.72). Median follow-up was 2.9 vs. 5.1 years. Two-year LRFS was 82% [95%CI: 74-88] for both groups; OS was 87% [95%CI: 80-92] vs. 88% [95%CI: 71-95]; and RFS was 72% [95%CI: 63-79] vs. 70% [95%CI: 52-83]. Postoperative complications were 53% vs. 35%, with wound disruption at 39% vs. 15% and infections at 29% vs. 6%. Grade 2 or higher dermatitis was 16% vs. 29%, and RT discontinuation rates were 4% vs. 12% for the two groups, respectively., Conclusion: Despite poorer prognostic factors in the preoperative RT group, LRFS and OS were comparable to those in the postoperative RT group. Postoperative complications were more frequent with preoperative RT, and treatment discontinuation was more common postoperatively., Competing Interests: Declarations. Ethics approval and consent to participate: The Institutional Review Board of the Oscar Lambret Center has confirmed that no ethical approval is required (number CEC-2023–003). The study complies with the “reference methodology” MR004 adopted by the French Data Protection Authority (CNIL). Inform consent was waived and we checked that patients did not object to the use of their clinical data for the research purpose. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: In the last 20 years, substantial improvements have been made in the diagnosis, treatment and management of patients with Prader-Willi syndrome (PWS). Few data on causes of death are available since those improvements were made. Our study assessed the causes of death among French patients with PWS over the first 11 years of experience of the nationwide French Reference Center for PWS (FRC-PWS)., Methods: Our study relied on two sources of mortality information at national level between 2004 and 2014: The French Epidemiological Centre for the Medical Causes of Death (CépiDc) Registry and the FRC-PWS database. Causes of death were classified into seven categories: respiratory, cardiovascular, gastrointestinal, severe infection, sudden death, other causes, and unknown. Descriptive statistics were calculated separately for children (< 18 years-old) and adults (≥18 years-old)., Results: One hundred and four deaths were identified in France from 2004 to 2014. The median age at death was 30 years, ranging from less than 1 month to 58 years. Seventeen deaths occurred in patients under 18 years, with 70% of them in children under 2 years. Respiratory causes accounted for more than 50% of the deaths in patients with PWS in both children and adults. Both cause and age of death did not significantly differ according to gender or genetic subtype., Conclusions: Patients with PWS die prematurely due to a respiratory cause in most cases at all ages. In those adult patients with data on obesity, 98% were reported to be obese.

Study Objectives: The aim of this study was to assess the frequency of past and current psychiatric disorders among patients referred to a sleep unit for polysomnography., Methods: A total of 152 patients referred to the Sleep Center of Timone Hospital in Marseille were included from January 12 to March 31, 2015. Clinical data were collected using the Mini International Neuropsychiatric Interview., Results: The final sample consisted of 102 patients. Polysomnography helped diagnose the following common sleep disorders: obstructive sleep apnea, restless legs syndrome, insomnia, and non-rapid eye movement sleep arousal disorder. Ninety patients (88%) had psychiatric disorders. All patients (27) without a common sleep disorder diagnosis had psychiatric disorders and among patients with a common sleep disorder diagnosis 84% had psychiatric disorders. Among the psychiatric disorders a past major depressive episode was the most frequent pathology., Conclusions: This study shows that patients referred to a sleep unit have a high prevalence of psychiatric disorders. This may be explained by residual symptoms of psychiatric illnesses, a diagnostic misdirection, a denial of psychiatric diagnosis, or an undiagnosed somatic symptom disorder. Finally, this study shows the importance of cross-disciplinary communication considering the diagnostic heterogeneity that may represent a sleep complaint., (© 2018 American Academy of Sleep Medicine.)

Between 1940 and 1944, an estimated 48,588 patients resident in French psychiatric hospitals died of starvation. Standard prisons, while facing similar problems, did not experience the same number of deaths by starvation, partly due to their ability to develop a black market for food and rations. Patients in psychiatric hospitals, on the other hand, were completely at the mercy of their doctors and the personnel in charge. At Hôpital du Vinatier, a psychiatric facility in Lyon, the mortality rate increased sharply from 1940 to 1944. In 1942, the worst year, 42% of patients died of hunger and exposure. In the end, more than 2,000 patients died at Vinatier. Was this due to a supposed lack of rations, or was it something more sinister? In Germany at the same time, tens of thousands of psychiatric patients died of purposeful starvation in psychiatric hospitals as part of the Nazi program of psychiatric euthanasia. Was the same thing occurring in Lyon?

Insomnia is a frequent symptom in the general population; numerous studies have proven this. In the past years, classifications have gradually given more emphasis to daytime repercussions of insomnia and to their consequences on social and cognitive functioning. They are now integrated in the definition of insomnia and are used to quantify its severity. If the daytime consequences of insomnia are well known at the clinical level, there are few epidemiological data on this matter. The aim of this study was to assess the daytime repercussions of insomnia complaints in the general population of France. A representative sample (n=5,622) aged 15 or older was surveyed by telephone with the help of the sleep-EVAL expert system, a computer program specially designed to evaluate sleep disorders and to manage epidemiological investigations. Interviews have been completed for 80.8% of the solicited subjects (n=5,622). The variables considered comprised insomnia and its daytime repercussions on cognitive functioning, affective tone, daytime sleepiness and diurnal fatigue. Insomnia was found in 18.6% of the sample. The prevalence was higher in women (22.4%) than in men (14.5%, p<0.001) with a relative risk of 1.7 (95% confidence interval 1.5 to 2) and was twice more frequent for subjects 65 years of age or older compared to subjects younger than 45 years. Approximately 30% of subjects reporting insomnia had difficulties initiating sleep. Nearly 75% of insomnia complainers reported having a disrupted sleep or waking up too early in the morning and about 40% said they had a non-restorative sleep. Repercussions on daytime functioning were reported by most insomnia subjects (67%). Repercussions on cognitive functioning changed according age, number of insomnia symptoms and the use of a psychotropic medication. A decreased efficiency was more likely to be reported by subjects between 15 and 44 years of age (OR: 2.9), those using a psychotropic (OR: 1.5), those reporting at least three insomnia symptoms (OR: 1.4) and women (OR: 1.4). The highest probability of the appearance of concentration difficulties was found in subjects younger than 65 Years, having a depressive disorder and using a psychotropic (15-44 years: OR 19.1; 45-64 years: OR 46.6). Difficulties maintaining attention were 15 times higher in subjects aged between 45 and 64 who were using a psychotropic and had also a depressive disorder. Memory difficulties were three times more likely to be reported by subjects using a psychotropic. At the affective level, irritability was 10 times more likely to be reported by subjects younger than 65 Years who were also using a psychotropic and had a depressive disorder. Independent of the presence of a mental disorder and the use of a psychotropic, subjects between 15 and 44 Years were five times more likely to be irritable following a bad sleep. Feeling depressed after a bad night's sleep was 18 times more likely to occur in subjects aged between 45 and 64 who were using a psychotropic and had a depressive disorder. Feeling anxious after a bad night's sleep was seven times more likely to occur in subjects with a depressive disorder. Daytime sleepiness was reported by approximately 20% of insomnia subjects. This rate was relatively comparable among gender, age groups, presence/absence of a mental disorder and use or not of a psychotropic. However, taking into account the interaction between age, use of a psychotropic and the presence of a mental disorder, subjects younger than 65 years, using a psychotropic and having a depressive disorder were at least 10 times more likely to report daytime sleepiness. Subjects who were suffering the most diurnal symptoms of insomnia were those younger than 65 years. Several factors can be evoked to explain this fact. These subjects were, for the most part, likelier to have a stricter sleep/wake schedule because of constraints imposed by work, studies, child care, etc. Subjects older than 65 Years were generally retired and therefore less prone to sleepiness and to cognitive difficulties. Insomnia consequences were limited due to their inactivity. Complementary studies should be undertaken to describe the daytime repercussions of insomnia for this specific age group of the general population and to measure these repercussions.

Several epidemiological surveys performed in Western Europe reported a prevalence of insomnia symptoms between 20% and 40% of the general population. Women and elderly individuals were the most affected. Many events can occur during sleep and affect its quality. Daytime sleepiness, a consequence of lack of sleep and/or insomnia, is responsible for many road, work and domestic accidents. Therefore, insomnia may have important consequences both for individuals and society. This study performed in the non institutionalized French population reports the sleep habits of that population and the factors associated with insomnia. This epidemiological study was conducted with 5,622 subjects representative of the French general population. They were aged between 15 and 96 Years. The participation rate was 80.8%. The results showed that men and women have different sleep habits. Generally speaking, women went to bed about 12 minutes earlier than men and woke up later than men (p<0.001). Women also took more time to fall asleep than men but only when they were aged between 35 and 65 Years. Furthermore, women had a longer sleep than men except between the ages of 55 and 74, where men slept significantly more than women. However, sleep efficiency was lower in women than in men who were over age 35. This was due to a greater frequency of nocturnal awakenings in women than in men. Sleep habits also changed with age: Bedtime became progressively earlier with advancing age and wake-up time was later when the subjects reached retirement age. Sleep latency progressively increased with age after 35. Similarly, disrupted sleep increased with age and was reported by more than half of subjects 75 years or older. We found also that evening or night workers showed irregularities in their sleep patterns: sleep latency was significantly longer - at least 12 minutes - compared to daytime and shift workers (p<0.001). They also had a shorter sleep duration of about 30 minutes compared to shift workers, and 40 minutes compared to daytime workers (p<0.001). Shift workers and evening or night workers had a lower sleep efficiency compared to daytime workers. Finally, in regions with greater density population (>100,000 inhabitants) sleep duration was shorter by approximately 10 minutes compared to localities with fewer than 5,000 residents (p<0.01). Similarly, bedtime and wake up hours were more related in regions with more than 100,000 inhabitants compared to small localities (fewer than 5,000 residents). Insomnia complaints, defined as the presence of at least one insomnia symptom accompanied by sleep dissatisfaction or use of a sleep medication, were reported by 18.6% of the sample. The prevalence was higher in women (22.4%) than in men (14.5%) and increased with age. However, the proportion of subjects dissatisfied with their sleep remained comparable for all age groups; it was the number of subjects using a sleep medication that increased with age. This was 3.2% in subjects 44 years or younger, 13.3% in subjects between 45 and 64 years, 22% of those between 65 and 74 years and almost a third of individuals 75 Years or older (32%; p<0.001). However, insomnia symptoms remained present for most of these consumers: 80.4% of those between 15 and 44 years, 87.9% of those between 45 and 64 Years, 81.4% of those between 65 and 74 years and 78.8% of subjects of 75 years or older. Compared to subjects in other epidemiological studies undertaken in England, Germany and Italy and using the same methodology, subjects in this study complained with their sleep more often. Insufficient sleep was found more often in the active population, which is subject to schedule constraints. Shift workers as well as evening or night workers were the most likely to have a sleep debt.

Untreated insomnia often has repercussions on socio-professional or cognitive functioning of insomniacs. In industrialized countries, the prevalence of insomnia ranges between 10% and 48%, depending on the methodology and the measured time interval. However, few studies have examined the relationship between insomnia and mental disorder diagnoses. This epidemiological study on insomnia complaints was conducted on 5 622 subjects representative of the non-institutionalized French population aged 15 years or over. Sixteen interviewers using the Sleep-EVAL expert system performed telephone interviews. Insomnia complaints (defined as difficulty initiating or maintaining sleep, feeling unrefreshed at awakening accompanied by dissatisfaction with sleep quality or quantity, or use of sleep-promoting medication) were observed in 18.6% (95% confidence interval: 17.6% to 19.6%) of the sample. The median duration of insomnia complaints was five years. Regional variations in the prevalence of insomnia complaints were observed in France. In North 2 and Center 4 regions, the prevalence of insomnia complaints was higher compared to the rest of France with a relative risk of 1.4 (95% confidence interval: 1.1-1.6) time superior for the North region and 1.3 (95% CI: 1.0-1.6) for the Center 4 region. The lowest prevalence was registered in the Mediterranean area. In most regions, the prevalence of insomnia complaints was higher in women than in men with the exception of the South and West regions where the prevalence was similar. Subjects with insomnia complaints consulted more frequently compared to the rest of sample with an odds ratio of 3 to 1 [95% CI: 2.8 to 4.1]. Close to 20% of subjects were being treated for a physical disease at the time of the survey; subjects with insomnia complaints being twice more numerous (34.3%) than the rest of the sample (15.9%; p<0.001). To identify the main factors associated with insomnia complaints, socio-demographic and health variables were introduced in a multivariate model. Separated or divorced individuals (OR: 1.6); widowers (OR: 1.5); subjects aged between 45 and 65 years (OR: 1.4) or older than 65 (OR: 1.5); women (OR: 1.3); those with little or no education (OR: 1.4); and subjects living in the North region had higher reported insomnia complaints. Living in the East region (Mediterranean) was a protective factor (OR: 0.6). Furthermore, subjects with vascular diseases (OR: 2.0), musculo-skeletal diseases (OR: 2.0) or cardiac diseases (OR: 1.9) and those who had consulted a physician in the previous six months (OR: 2.7) had higher a probability of insomnia complaints. Subsequently, DSM IV insomnia diagnoses were examined in subjects who complained of insomnia. A diagnosis of primary insomnia was found in 7% of these subjects. A diagnosis of insomnia related to another mental disorder was found in 15.6% of insomnia complainers. A depressive disorder diagnosis was given in 10.8% of cases (mainly a major depressive disorder). This diagnosis was made more often among women and subjects of less than 65 years. An anxiety disorder diagnosis was given for 33.1% of insomnia complainers (an anxiety generalized disorder in about half the cases). About a quarter of insomnia complainers did not receive a diagnosis. This was the case more often for men and the subjects 65 years or older. If demographic and medical factors are relatively well documented at the epidemiological level, it is otherwise for psychiatric diagnosis associated with insomnia complaint. Very few studies in the general population have been done and still fewer of them have applied a positive and differential diagnosis process. In this study, we used the DSM IV classification to establish positive and differential diagnoses among subjects with insomnia complaints. Compared to other epidemiological studies, our study is distinguished by several aspects: 1) insomnia complaint had a narrower definition. It did not suffice that the subject reported insomnia symptoms, it was also necessary that the subject said s/he was dissatisfied with her/hr/his sleep or that s/he took measures to improve it (medication or sleep hygiene). This choice was motivated essentially by the fact that it is difficult, from a point of clinical point of view, to consider that an individual has insomnia solely based on the presence of symptoms, that, appreciated by a clinician, would resemble insomnia without that they make problem for the subject. 2) Several sleep habits were systematically collected. The majority of epidemiological studies are not centered on sleep problems, with the consequence that results do not allow a global view of factors that are associated with insomnia. 3) The various diagnostic categories of insomnia as well as elements of the differential diagnosis were applied. Thus, we can conclude that insomnia, as a diagnostic entity, including all its forms, is found in 5.6% of the French population. In the majority of cases, the insomnia complaint is part of the symptomatology of a mental disorder, mainly an anxiety disorder. This distinction is important since it helps the physician to determine therapeutic choices. To conclude, it is worthwhile to consider the number of insomnia complainers who had consulted a physician, mainly a general practitioner, in the six months prior to the study. This designates physicians as the first-line resource in the treatment and the prevention of sleep disorders.

Although frequently investigated in the general population, the epidemiology of insomnia complaints and their treatment have received little attention in general practice. This study recruited patients > or =15 years of age, consecutively, from 127 general practitioners in France. The physicians collected data from 11,810 of their patients, of whom 55.5% were women. Insomnia complaints were reported by 26.2% (25.4% to 27%) of the sample and use of sleep-promoting medication by 10.1% (9.7% to 10.7%). About 47% of the prescribed drugs used were anxiolytics and 45% hypnotics. Most consumers took sleep-enhancing drugs on a daily and long-term basis and most reported that the medication improved their quality of sleep. However, few distinctions emerged between elderly drug-taking insomniacs and elderly nontreated insomniacs with respect to the various dimensions of sleep. Results underscore the persistent general tendency among French general practitioners to overprescribe anxiolytics for the treatment of insomnia complaints and that they do so on a long-term basis, despite the findings of numerous studies showing that benzodiazepines are ineffective in the treatment of sleep complaints over the long term.

The co-occurrence of insomnia and mental disorders constitutes the most prevalent diagnosis pattern found in sleep disorder clinics. Yet, there remains a paucity of epidemiological information regarding comorbidity of mental disorders and sleep disorder symptomatology in the general population. The present study showed results based on a large representative French cohort (n = 5,622; 80.7% of the contacted stratified sample). A total of 997 (17.7%) individuals with insomnia complaints were identified and divided into six diagnostic categories: (1) Insomnia related to a Depressive Disorder; (2) Insomnia related to an Anxiety Disorder; (3) Depressive Disorder accompanied by insomnia symptomatology; (4) Anxiety Disorder accompanied by insomnia symptomatology; (5) Primary Insomnia; and (6) isolated insomnia symptomatology. Telephone interviews were conducted using the Sleep-Eval System. Subjects with insomnia related to a Mental Disorder have a longer history of insomnia complaints and are usually younger than those with Depressive or Anxiety Disorders accompanied by insomnia symptoms. Subjects with Insomnia related to a Depressive Disorder experienced more repercussions than any other group. A surprisingly high percentage of individuals with depressive symptomatology had sought independent medical treatment specifically for their sleep problems, which raises the unsettling possibility that many cases of depression go undetected by the general medical community. The distinct predictability of commonly undiagnosed depression leading to chronic depression speaks directly to the imperative that physicians receive additional training in this area of community mental health.

The aging population in western countries and the increase in longevity make the problem of recognition and treatment of sleep disorders more acute in the elderly population. The risk of evolution of sleep disorders in the elderly leads to a greater weakness of their physical health, a greater dependence on their environment, and finally to more frequent recourse to institutionalization. We investigated sleep habits, sleep disorders and psychiatric diagnoses, physical illnesses and psychotropic drug consumption in a representative sample of the general population of France. Interviews were performed over the telephone by lay interviews using the Eval Knowledge Based System, a computerized system that guides the interviewer through the interview process, 6966 subjects were contacted, and 5622 interviews (80.8% of the potential sample) were completed. The sample was divided into four age groups: 15 to 44 years old (56.4%); 45 to 64 years old (25.6%); 65 to 74 years old (10.8%) and 75 years old or more (7.2%). Earlier bedtime, long sleep latency, spending more time in bed with a reduction of nocturnal sleep time, nocturnal awakenings and daytime naps were found more frequently in "young old" (65 to 75 years old) and "old old" subjects (75 years old or more). Daytime naps and spending more time in bed with a reduction of nocturnal sleep time also distinguished "old old" subjects from "young old" subjects. About half of "old old" subjects who complained about their sleep did not get a diagnosis of sleep disorder, nor psychiatric disorder (52.4%). An insomnia diagnosis was given in 14% of cases (mostly primary insomnia-6.7%) and a psychiatric diagnosis in 33.4% of cases (mostly anxiety diagnoses-28.2%). The rate of psychotropic drug consumption was 11.7% (95% Cl: 10.9% to 12.5%) for the entire sample. This consumption dramatically increased with age: 4.8% between 15 to 44 years old; 15.6% between 45 to 64 years old; 24.3% in "young old" subjects and 32.8% in "old old" subjects. Psychotropic drug consumption was distributed as follows: 6.4% of the sample used anxiolytic, 2.7% hypnotic, 1.5% antidepressant and 0.9% hypnotic and anxiolytic together. The chronic use (at least one year) of hypnotic or anxiolytic drugs was frequent in "old old" subjects (92.6% and 80.2%, respectively) and "young old" subjects (74% and 78% respectively). The assessment of sleep by the physician should be made part of the routine clinical examination of older subjects. Review of the etiology of insomnia complaints is crucial in the choice of treatment. The reflex of psychotropic prescription in case of poor sleep is neither sufficient nor desirable, especially because of the risk of chronic use of the prescription. These data underline the importance of educating physicians about consequences of long-term utilization of these drugs and on the need for sleep hygiene measures as alternative solutions for treating insomnia complaints.

The responsibility of psychotropic drugs as a cause of road traffic accidents remains difficult to evaluate with precision. Different studies performed in many countries provide a certain precision in relation to percentage of injured drivers whose blood contained psychotropic substances (8 to 10% according to studies). On the other hand, it is practically impossible to really know either these products were or were not the cause of the accidents because underlying or associated pathologies can equally create problems such as lack of attention and other vigilance deficits. There is also a possibility of suicidal or aggressive tendencies. A certain number of circadian and other chronobiological parameters also complicate the problem since the schedule (hour) as well as the day of the week or even the season can considerably modify vigilance and reaction time. Available medications able to create such problems are numerous and their mechanisms of action varied. They can influence vision, impulsiveness and vigilance. They can act either by direct mechanisms of sedation or, on the contrary, by raising inhibition through secondary mechanisms: delay in drug elimination or provoked insomnia. For the most part, incriminated medications belong to the different classes of sedative medicines: benzodiazepines, antiepileptics, some antihistaminic agents, some antidepressants, some thymo-regulators and some anti-hypertensives. Also included are desinhibitors or stimulant classes: amphetamines and related drugs, caffeine and codeine. Some of them can be used for their psychodysleptic properties: codeine and anticholinergic drugs. Finally, drug and medicinal associations can have unforeseen effects: for example, anticholinergics + alcohol + valpromide, etc. If it appears methodologically impossible that research could ever precisely quantify the share of responsibility of psychotropic drugs in causing road traffic accidents, this relation remains highly probable. It is therefore necessary that in the course of university and post-academic training, potential prescribers might regularly be advised of these risks. Lastly, public needs to be constantly informed.

Thirty years after recognition of the fetal alcohol syndrome, a study of 105 affected individuals who reached adulthood provides insight into the long-term outcome of this condition. The typical facial dysmorphism undergoes odd changes, often with a long face and a bulky nose and chin, in contrast to the appearance of affected infants. The growth failure becomes slightly less marked. The malformations, which occur in 3/4 of severe forms, increase the disability although function is sometimes better than expected. In contrast, the microcephaly becomes more pronounced. This explains the psychic disorders which are the main prognostic factor: mental retardation in the most severely affected patients or severe learning disabilities and, in every case, behavior disorders and marked instability. Similar disorders are often found in siblings with no apparent dysmorphism underlining the extent of the problem and the urgent need for prophylaxis. Some of the observations made in adults, confronted to embryologic data, lead to useful inferences with respect to prophylaxis.

This new "turn of the century", at least in France, is marked by an increasing discrepancy between laws and new medical discoveries. Medical practitioners, scientists and researchers have had such a fantastic power and, as a consequence, the patients have never run such an important risk of loosing human dimensions. The basic question is the legal status of the human body. Until now, common law considers human being as a citizen whose liberty should be limited under certain conditions. However, this point of view poorly prepares to rule man as a creature of flesh and sentiment. There is an almost complete deficit of the legal statute of man in his globality, especially concerning the juridical status of the human body which is totally lacking as a whole in the french civil code. Human body represents a double legal problem: is its integrity a private or a public privilege? Are his dignity and identity really warranted for everyone?

This article presents a comparison of research ethics in psychopharmacology in France and the United States. The authors present some elements of definition, etymology and of history. In addition, they study how this very specific research is actually done. Many questions are discussed, including the right of the patient, and the problem of normal volunteers. Other aspects are more technical i.e. remuneration, protocol, and the product. Finally the role of the ethics committees is investigated. These committees comprise the third component of the trial that consists of the research and the subject.