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Dans un contexte de violence sociale et de grande precarite, les flux migratoires contemporains remettent en question nos dispositifs de prise en charge et le setting individuel en particulier. A travers la presentation d’un dispositif original – le Photolangage® – qui prevoit l’utilisation de la mediation des images dans le groupe, nous montrerons comment le recours au groupe et a la mediation pour la prise en charge de requerants d’asile peut s’averer un apport interessant pour relancer les processus associatifs et de representation des affects, d’un cote, et pour explorer les traces traumatiques sous-jacentes, liees aux violences sociales et collectives, de l’autre.

Vitamin D toxicity is associated with accidental overdoses due to manufacturing or intake errors and its secondary hypercalcemia can result in severe morbidity. Although patients with cystic fibrosis are potentially at increased risk for this intoxication as prescription of vitamin D preparations is a common practice in this population, the frequency of such events is currently unknown. We performed a retrospective analysis of all the files of cystic fibrosis patients followed at the Cliniques universitaires Saint-Luc over a 10-year period, recording 25(OH)- and 1,25(OH)2vitamin D levels as well as demographic data, lung function tests, Pseudomonas aeruginosa infection and results from pharmacological analysis of magistral liposoluble vitamins preparations. A total of 244 patients were included in the study. 13 patients (5%) had serum vitamin D levels corresponding to vitamin D overdose. Patients who had experienced an overdose were more likely to be F508del homozygous or suffer from exocrine pancreatic insufficiency. 2 patients developed significant hypercalcemia necessitating monitoring and hospitalization. Errors in the preparation of magistral liposoluble vitamin pills were identified in several intoxicated patients. Retrospective assessment of the dosing errors with the local pharmacists showed that trituration and dosing errors were their most frequent causes.

Nous sommes de plus en plus confrontes a des situations de renvoi dans le cadre des accords de Dublin. Les autorites, parfois l’opinion publique, semblent considerer que ces renvois ne devraient pas poser de probleme. Nous constatons qu’ils peuvent repeter un traumatisme et amener a des symptomes ou troubles psychiatriques graves chez des personnes pour qui, la plupart du temps, on ne retrouve pas d’antecedents psychiatriques. A travers une vignette clinique et dans un climat d’urgence et d’injonction a l’agir, nous avons voulu montrer l’importance de preserver une reflexion psychopathologique et d’eviter certains pieges contre-transferentiels. Ces questions, avant tout cliniques mais egalement ethiques, sont abordees a travers le travail en equipe dans un centre de crise a Geneve.

Salivary cortisol assay, described for the first time almost forty years ago, has not been expanding until the last decade. Its simplicity, non-invasiveness and the easy repetition of sampling make it an analytical matrix of interest. Since the publication of the recommendations of the American endocrinology society in 2008, salivary cortisol is recognized as one of the three main tests to screen for Cushing's syndrome. In addition, salivary cortisone, the major metabolite of salivary cortisol, still represents a severe potential interferent but could also be a complementary analyte for indications where evaluation of cortisol secretion is sought. Moreover, in the current context of practices and methods harmonization, the problem of lack of standardization presents also for salivary cortisol. This review briefly develops the three main tests of Cushing's syndrome screening to explain the reasons for integrating the saliva test into this screening. Then we will develop the variables that can influence salivary cortisol from a pre-analytic, physiopathological and finally analytical point of view.

BackgroundStudies have shown high levels of distress and mental disorder among people living in refugee camps, yet none has confirmed diagnosis through clinical reappraisal.AimsTo estimate the prevalence of mental disorders, related disability and treatment gap in adult refugees living in the Burj el-Barajneh camp.MethodRandomly selected participants were screened by household representative (n = 748) and individual (n = 315) interviews; clinical reappraisal was performed on a subset (n = 194) of 326 selected participants. Weighted prevalence estimates and 95% confidence intervals were calculated.ResultsThe prevalence of current mental disorders was 19.4% (95% CI 12.6–26.2); depression was the most common diagnosis (8.3%, 95% CI 4.4–12.2) and multiple diagnoses were common (42%) among the 88 persons with mental disorder. Lifetime prevalence of psychosis was 3.3% (95% CI 1.0–5.5). Mental disorders were associated with moderate to severe dysfunction (odds ratio = 8.8, 95% CI 4.5–17.4). The treatment gap was 96% (95% CI 92–100).ConclusionsA range of mental disorders and associated disability are common in this long-term refugee setting. Combined with an important treatment gap, findings support the current consensus-based policy to prioritise availability of mental health treatment in refugee camps, especially for the most severe and disabling conditions.

Background Time and resource efficient mental disorder screening mechanisms are not available to identify the growing number of refugees and other forcibly displaced persons in priority need for mental health care. The aim of this study was to identify efficient screening instruments and mechanisms for the detection of moderate and severe mental disorders in a refugee setting. Methods Lay interviewers applied a screening algorithm to detect individuals with severe distress or mental disorders in randomly selected households in a Palestinian refugee camp in Beirut, Lebanon. The method included household informant and individual level interviews using a Vignettes of Local Terms and Concepts for mental disorders (VOLTAC), individual and household informant portions of the field-test version of the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS) and the WHO Self Reporting Questionnaire (SRQ-20). A subset of participants were then reappraised utilizing the Mini International Neuropsychiatric Interview (MINI), WHO Disability Assessment Schedule II, and the Global Assessment of Functioning. The study constitutes a secondary analysis of interview data from 283 randomly selected households (n = 748 adult residents) who participated in a mental health disorders prevalence study in 2010. Results The 5-item household informant portion of WASSS was the most efficient instrument among those tested. It detected adults with severe mental disorders with 95% sensitivity and 71% specificity (Area Under Curve (AUC) = 0.85) and adults with moderate or severe mental disorder with 85.1% sensitivity and 74.8% specificity (AUC = 0.82). The complete screening algorithm demonstrated 100% sensitivity and 58% specificity. Conclusions Our results suggest that a two phase, screen-confirm approach is likely a useful strategy to detect incapacitating mental disorders in humanitarian contexts where mental health specialists are scarce, and that in the context of a multi-step screen confirm mechanism, the household informant portion of field-test version of the WASSS may be an efficient screening tool to identify adults in greatest need for mental health care in humanitarian settings. Electronic supplementary material The online version of this article (doi:10.1186/s12888-016-1154-5) contains supplementary material, which is available to authorized users.

This paper is concerned with a floor application calendering processing using both a PVC and a Polyolefin formulation within a two roll calender. The rheology of both formulations was measured using the Rheoplast, a specific capillary rheometer. Experiments with various velocity differentials were performed and the roll separating force and the sheet exit temperature were measured for each case. An isothermal model based on the lubrication approximations hypothesis together with a power-law behavior for the molten polymer has been developed. Due to the difference between the rotation velocities of the two cylinders, the problem is no longer symmetric and the integration of the generalized Reynolds equation requires taking into account various velocity profiles. The resulting pressure profile enables computation of the roll separating force. The agreement between the model and experiments performed with the PVC formulation at various velocity differentials is fair; however for the Polyolefin formulation there is a significant difference which means that the model for this new formulation needs to be improved.

BACKGROUND: There is little evidence on the effectiveness of services for the care of people with mental disorders among refugee populations. Médecins sans Frontières (MSF) has established a mental health centre in a mixed urban-refugee population in Beirut to respond to the significant burden of mental health problems. Patients received comprehensive care through a multidisciplinary team. A cohort of people with common and severe mental disorders has been analysed between December 2008 and June 2011 to evaluate individual outcomes of treatment in terms of functionality. METHODS: All patients diagnosed with mental disorders were included in the study. The Global Assessment of Functioning (GAF) and the Self Reporting Questionnaire-20 items (SRQ 20) were used as tools for baseline assessment, monitoring and evaluation of patients. Predictors of evolution of SRQ20 and GAF over visits were explored using a linear mixed model. RESULTS: Up to June 2011, 1144 patients were followed, 63.7% of them Lebanese, 31.8% Palestinians and 1.2% Iraqis. Females represented 64.2% of the patient population. Mean age was 39.2 years (28.5-46.5). The most frequent primary diagnoses were depressive disorders (28.8%), anxiety disorders (15.6%) and psychosis (11.5%). A lower baseline SRQ20 score/higher baseline GAF score (indicators of severity), being diagnosed with anxiety (compared to being diagnosed with depression or psychosis) and a higher level of education were associated with better outcomes. DISCUSSION: In this MSF program, we observed a significant decrease of SRQ20 individual scores and a significant increase of individual GAF scores. This corresponded to an improvement in the functionality of our patients. Analysis of the predictors of this positive evolution indicates that we need to adapt our model for the more severe and less educated patients. It also makes us reflect on the length of the individual follow-up. Further research could include a qualitative evaluation of the intervention. Results of this study have been presented at the World Congress of the World Federation for Mental Health in Cape Town, October 2011.

Epidemiologically, Burkitt's tumor should be common in the Congo Basin; actually, it appears to be the most common childhood tumor in the Lower Congo. Fifteen cases were seen at the Institut Medical Evangelique, Kimpese from January 1965 through February 1967. Jaw tumors were the presenting symptom in 86% of the cases. In this series chemotherapy seemed to be less effective than reported by Burkitt, probably due to smaller dosage of the drugs. It seems to be significant that all the patients came from rural areas.