Une intervention systémique brève de couple: le cas de Virginie et Paul

L'analyse de la thérapie de couple de Virginie et Paul vise à illustrer la spécificité de l'intervention Systémique Brève, un traitement manualise réalisé dans un cadre temporel limité, et à examiner son efficacité. L'évaluation chez chaque conjoint de la symptomatologie individuelle, de la satisfaction conjugale et de l'alliance thérapeutique grâce à des questionnaires transmis avant, après et trois mois après la fin de l'intervention fournit une mesure indépendante du processus thérapeutique. Les résultats montrent que les étapes clés du processus thérapeutique identifiées par les thérapeutes sont associées à des variations de l'alliance thérapeutique chez les patients. L'évolution distincte de chaque partenaire est discutée, en s'appuyant notamment sur les réactions des conjoints à leurs données de recherche.

Methadone treatments in a Swiss Region, 2001-2008: a registry-based analysis.

ABSTRACT: BACKGROUND: To determine, in a region of Switzerland, the duration of retention in opioid substitution treatments with methadone (OSTM), duration of treatment interruptions, probability of re-entry to treatment after a treatment interruption, and associated factors. METHODS: A secondary analysis of registry-based data was performed with patients (n = 2880) registered in the methadone treatment register database of the Public Health Service of the canton of Vaud between January 1, 2001 and June 30, 2008. Survival analysis and multivariate analysis was conducted. RESULTS: The probability of remaining on treatment was 69% at 1 year and 45% at 3 years (n =1666). One-third of patients remained on treatment beyond 5 years. The estimated hazard of leaving treatment was increased by a ratio of 1.31 in the case of a first treatment (P = 0.001), 1.83 for those without a fixed home (P < 0.001), and 1.29 for those younger than 30 years old (P < 0.001). The probability of having begun a new treatment after a first interruption was 21% at one year, 38% at 3 years, and 43% at 5 years (n = 1581). Factors at the interruption of treatment associated with a higher probability of re-entering were: interruption not due to methadone withdrawal, bad physical health, and higher methadone dose. CONCLUSIONS: OSTM are long-term (maintenance) treatments in Switzerland. Younger age, bad living conditions at entry, and first treatment are predictors of lower retention. Approximately one-half of patients who interrupt treatment will re-enter treatment within 5 years.

Treatment of adult-onset Still's disease: a review

Adult-onset Still's disease (AOSD) is a rare inflammatory disorder that has been recently classified as a polygenic autoinflammatory disorder. The former classification, based on the disease course, seems to be quite dated. Indeed, there is accumulating evidence that AOSD can be divided into two distinct phenotypes based on cytokine profile, clinical presentation, and outcome, ie, a "systemic" pattern and an "articular" pattern. The first part of this review deals with the treatments that are currently available for AOSD. We then present the different strategies based on the characteristics of the disease according to clinical presentation. To do so, we focus on the two subsets of the disease. Finally, we discuss the management of life-threatening complications of AOSD, along with the therapeutic options during pregnancy.

Psychiatre et psychothérapeute ? Petite histoire suisse

L'histoire de la psychiatrie et de la psychothérapie en Suisse est riche et complexe. Après un survol des événements survenus pendant la première moitié du XX e siècle, cet article décrit les modifications des exigences de formation pour le double titre de psychiatre et psychothérapeute FMH depuis la date de son adoption en 1961, en comparaison notamment avec la situation française. Les enjeux théoriques (débats d'écoles), cliniques (intégration de la psychothérapie dans les programmes de soin), scientifiques (efficacité des psychothérapies), économiques (économicité des psychothérapies), professionnels (place des médecins et des psychologues) et politiques (reconnaissance des titres et des traitements) associés à cette double formation sont esquissés.

A set of indicators for decomposing the secular increase of life expectancy.

ABSTRACT: BACKGROUND: The ongoing increase in life expectancy in developed countries is associated with changes in the shape of the survival curve. These changes can be characterized by two main, distinct components: (i) the decline in premature mortality, i.e., the concentration of deaths around some high value of the mean age at death, also termed rectangularization of the survival curve; and (ii) the increase of this mean age at death, i.e., longevity, which directly reflects the reduction of mortality at advanced ages. Several recent observations suggest that both mechanisms are simultaneously taking place. METHODS: We propose a set of indicators aiming to quantify, disentangle, and compare the respective contribution of rectangularization and longevity increase to the secular increase of life expectancy. These indicators, based on a nonparametric approach, are easy to implement. RESULTS: We illustrate the method with the evolution of the Swiss mortality data between 1876 and 2006. Using our approach, we are able to say that the increase in longevity and rectangularization explain each about 50% of the secular increase of life expectancy. CONCLUSION: Our method may provide a useful tool to assess whether the contribution of rectangularization to the secular increase of life expectancy will remain around 50% or whether it will be increasing in the next few years, and thus whether concentration of mortality will eventually take place against some ultimate biological limit.

Subclinical hypothyroidism and functional mobility in older adults.

BACKGROUND: Health risks associated with subclinical hypothyroidism in older adults are unclear. Our objective was to compare the functional mobility of people aged 70 to 79 years by thyroid function categorized by thyrotropin (TSH) level as euthyroid (>or=0.4 to <4.5 mIU/L), mild subclinical hypothyroid (>or=4.5 to <7.0 mIU/L), or moderate subclinical hypothyroid (>or=7.0 to <or=20.0 mIU/L with a normal free thyroxine level) cross-sectionally and over 2 years. METHODS: A total of 2290 community-dwelling residents participating in the year 2 clinic visit (July 1998-June 1999) of the Health, Aging, and Body Composition (Health ABC) Study, who had measured TSH level, had the capacity to walk 20 m unaided, and were not taking thyroid medication or had TSH levels consistent with hyperthyroidism or hypothyroidism. Main outcome measures included self-reported and performance-based measures of mobility (usual and rapid gait speed and endurance walking ability) assessed at study baseline (year 2) and 2 years later. RESULTS: In age- and sex-adjusted analyses, the mild subclinical hypothyroid group (vs the euthyroid group) demonstrated better mobility (faster mean usual and rapid gait speed [1.20 vs 1.15 m/s and 1.65 vs 1.56 m/s, respectively; P < .001] and had a higher percentage of those with good cardiorespiratory fitness and reported walking ease [39.2% vs 28.0% and 44.7% vs 36.5%, respectively; P < .001]). After 2 years, persons with mild subclinical hypothyroidism experienced a similar decline as the euthyroid group but maintained their mobility advantage. Persons with moderate subclinical hypothyroidism had similar mobility and mobility decline as the euthyroid group. CONCLUSION: Generally, well-functioning 70- to 79-year-old individuals with subclinical hypothyroidism do not demonstrate increased risk of mobility problems, and those with mild elevations in TSH level show a slight functional advantage.

The family alliance assessment scales : steps toward validity and reliability of an observational assessment tool for early family interactions

We present the first steps in the validation of an observational tool for father-mother-infant interactions: the FAAS (Family Alliance Assessment Scales). Family-level variables are acknowledged as unique contributors to the understanding of the socio-affective development of the child, yet producing reliable assessments of family-level interactions poses a methodological challenge. There is, therefore, a clear need for a validated and clinically relevant tool. This validation study has been carried out on three samples: one non-referred sample, of families taking part in a study on the transition to parenthood (normative sample; n = 30), one referred for medically assisted procreation (infertility sample; n = 30) and one referred for a psychiatric condition in one parent (clinical sample; n = 15). Results show that the FAAS scales have (1) good inter-rater reliability and (2) good validity, as assessed through known-group validity by comparing the three samples and through concurrent validity by checking family interactions against parents' self-reported marital satisfaction.