Teachers' sick leave due to mental and behavioral disorders and return to work

This manuscript presents a review of the literature about medical leaves due to mental and behavioral disorders and return to work of teachers. There are scarce published manuscripts. Most articles relate with prevalence of mental disorders and factors associated with the work organization, and did not mention intervention proposals and or changes in the work organization and teaching work. Proposed actions are discussed.

Male/Female Manifestations of Narcissistic Personality and Behavioral Disorders.

Specifically, this paper will address the following topics : 1. The history of psychoanalytic thinking onnarcissism will be discussed, leading up to more recent ideas on the narcissistic personality disorder. 2. Drawing on historical and current ideas, an integrated definition of the narcissistic personality disorder will be presented and elaborated upon, including an examination of differing male/female narcissistic compensatory styles. 3. To foster an understanding of the development of narcissistic defenses and of differing gender styles of defense, various theories relating to gender differences in the narcissistic personality disorder will be explored: self/object relations theories, Kohut's theory on narcissism, psychosexual development theories, behavioral manifestation theories, and bodily development theories.4. The role of preoedipal development, as it relates to the formation of the male/female narcissistic personality disorder, will be examined. This section of the paper will propose that, in the narcissistic personality disorder, a pathological arrest occurred during the second or third year of life in response to trauma experienced at that time. The degree and timing of the trauma and the degree of structuralization preceding the trauma all contribute to the rigidity of the narcissistic disorder and the severity of the pathology. 5. The role of oedipal development in the male/female narcissistic personality disorder will be discussed. This discussion will address the intrapsychic configurations which arise during the oedipal period, after narcissistic defenses have solidified during the preoedipal years. While narcissism can be seen as a developmental line, with narcissistic defenses arising at any time during development, this paper will focus primarily on defenses which arise during the separation/individuation phases of development.

Behavioral profile of adults with Prader-Willi syndrome : correlations with individual and environmental variables

Background: Maladaptive behavior has been reported as a phenotypical feature in Prader–Willi syndrome (PWS). It severely limits social adaptation and the quality of life of children and adults with the syndrome. Different factors have been linked with the intensity and form of these behavioral disturbances but there is no consensus about the cause. Consequently, there is still controversy regarding management strategies and there is a need for new data. Methods: The behavior of 100 adults with PWS attending a dedicated center was assessed using the Developmental Behavior Checklist for Adults (DBC-A) and the PWS-specific Hyperphagia Questionnaire. The DBC-A was completed separately by trained caregivers at the center and relatives or caregivers in a natural setting. Genotype, gender, age, degree of obesity and cognitive impairment were analyzed as variables with a hypothetical influence on behavioral features. Results: Patients showed a relatively high rate of behavioral disturbances other than hyperphagia. Disruptive and social relating were the highest scoring DBC-A subscales whereas anxiety/antisocial and self-absorbed were the lowest. When hospital caregiver and natural caregiver scores were compared, scores for the latter were higher for all subscales except for disruptive and anxiety/antisocial. These effects of institutional management were underlined. In the DBC-A, 22 items have descriptive indications of PWS behavior and were used for further comparisons and correlation analysis. In contrast to previous reports, rates of disturbed behavior were lower in patients with a deletion genotype. However, the behavioral profile was similar for both genotypes. No differences were found in any measurement when comparing type I and type II deletions. The other analyzed variables showed little relevance. Conclusions: Significant rates of behavioral disorders were highlighted and their typology described in a large cohort of adults with PWS. The deletion genotype was related to a lower severity of symptoms. Some major behavioral problems, such as hyperphagia, may be well controlled if living circumstances are adapted to the specific requirements of individuals with PWS.

Long-term outcome after cognitive and behavioral regression in nonlesional epilepsy with continuous spike-waves during slow-wave sleep.

PURPOSE: To present the long-term follow-up of 10 adolescents and young adults with documented cognitive and behavioral regression as children due to nonlesional focal, mainly frontal, epilepsy with continuous spike-waves during slow wave sleep (CSWS). METHODS: Past medical and electroencephalography (EEG) data were reviewed and neuropsychological tests exploring main cognitive functions were administered. KEY FINDINGS: After a mean duration of follow-up of 15.6 years (range, 8-23 years), none of the 10 patients had recovered fully, but four regained borderline to normal intelligence and were almost independent. Patients with prolonged global intellectual regression had the worst outcome, whereas those with more specific and short-lived deficits recovered best. The marked behavioral disorders resolved in all but one patient. Executive functions were neither severely nor homogenously affected. Three patients with a frontal syndrome during the active phase (AP) disclosed only mild residual executive and social cognition deficits. The main cognitive gains occurred shortly after the AP, but qualitative improvements continued to occur. Long-term outcome correlated best with duration of CSWS. SIGNIFICANCE: Our findings emphasize that cognitive recovery after cessation of CSWS depends on the severity and duration of the initial regression. None of our patients had major executive and social cognition deficits with preserved intelligence, as reported in adults with early destructive lesions of the frontal lobes. Early recognition of epilepsy with CSWS and rapid introduction of effective therapy are crucial for a best possible outcome.

Behavioral and neuroendocrine effects of the exposure to chronic restraint or variable stress in early adolescent rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Non-Substance-Related Disorders: Gambling disorder and internet addiction

Behavioral addictions are highly prevalent and have a major individual and societal impact. Moreover, given the availability and increase of potentially addictive activities in our societal development (e.g. internet, gaming, online pornography) an increase in these types of behavioral disorders is very likely. Gambling Disorders are best studied among the non-chemical addictions. However, effective treatment interventions need to be further developed, in particular for Internet Addiction. Most of the available evidence supports behavioral interventions as first line treatment. Specifically for Gambling Disorder, pharmacotherapy can be an useful augmentation.. Psychiatric comorbidities are frequent in patients with behavioral addictions and negatively affect the course of non-substance-related disorders. Concurrent treatment of these comorbid disorders is advised, although there is a clear need of conducting studies evaluating the effectiveness of integrated treatment approaches.

Class placement and academic and behavioral variables as predictors of graduation for students with disabilities

Dropout rates impacting students with high-incidence disabilities in American schools remain staggering (Bost, 2006; Hehir, 2005). Of this group, students with Emotional Behavioral Disorders (EBD) are at greatest risk. Despite the mandated national propagation of inclusion, students with EBD remain the least included and the least successful when included (Bost). Accordingly, this study investigated the potential significance of inclusive settings and other school-related variables within the context of promoting the graduation potential of students with Specific Learning Disabilities (SLD) or EBD. This mixed-methods study investigated specified school-related variables as likely dropout predictors, as well as the existence of first-order interactions among some of the variables. In addition, it portrayed the perspectives of students with SLD or EBD on the school-related variables that promote graduation. Accordingly, the sample was limited to students with SLD or EBD who had graduated or were close to graduation. For the quantitative component the numerical data were analyzed using linear and logistic regressions. For the qualitative component guided student interviews were conducted. Both strands were subsequently analyzed using Ridenour and Newman’s (2008) model where the quantitative hypotheses are tested and are later built-upon by the related qualitative meta-themes. Results indicated that a successful academic history, or obtaining passing grades was the only significant predictor of graduation potential when statistically controlling all the other variables. While at a marginal significance, results also yielded that students with SLD or EBD in inclusive settings experienced better academic results and behavioral outcomes than those in self-contained settings. Specifically, students with SLD or EBD in inclusive settings were found to be more likely to obtain passing grades and less likely to be suspended from school. Generally, the meta-themes yielded during the student interviews corroborated these findings as well as provided extensive insights on how students with disabilities view school within the context of promoting graduation. Based on the results yielded, provided the necessary academic accommodations and adaptations are in place, along with an effective behavioral program, inclusive settings can be utilized as drop-out prevention tools in special education.

Comparison of repeated and two non-repeated readings conditions on reading abilities of students with emotional and/or behavioral disabilities

Students with emotional and/or behavioral disorders (EBD)present considerable academic challenges along with emotional and/or behavioral problems. In terms of reading, these students typically perform one-to-two years below grade level (Kauffman, 2001). Given the strong correlation between reading failure and school failure and overall success (Scott & Shearer-Lingo, 2002), finding effective approaches to reading instruction is imperative for these students (Staubitz, Cartledge, Yurick, & Lo, 2005). This study used an alternating treatments design to comparethe effects of three conditions on the reading fluency, errors, and comprehension of four, sixth-grade students with EBD who were struggling readers. Specifically, the following were compared: (a) Repeated readings in which participants repeatedly read a passage of about 100-150 words, three times, (b) Non-repeated readings in which participants sequentially read an original passage of about 100-150 words once, and (c) Equivalent non-repeated readings in which participants sequentially read a passage of about 300-450 words, equivalent to the number of words in the repeated readings condition. Also examined were the effects of the three repeated readings practice trials per sessions on reading fluency and errors. The reading passage difficulty and length established prior to commencing were used for all participants throughout the standard phase. During the enhanced phase, the reading levels were increased 6 months for all participants, and for two (the advanced readers), the length of the reading passages was increased by 50%, allowing for comparisons under more rigorous conditions. The results indicate that overall repeated readings had the best outcome across the standard and enhanced phases for increasing readers’ fluency, reducing their errors per minute, and supporting fluency answers to literal comprehension questions correctly as compared to non-repeated and equivalent non-repeated conditions. When comparing nonrepeated and equivalent non-repeated readings,there were mixed results. Under the enhanced phases, the positive effects of repeated readings were more demonstrative. Additional research is needed to compare the effects of repeated and equivalent non-repeated readings across other populations of students with disabilities or varying learning styles. This research should include collecting repeated readings practice trial data for fluency and errors to further analyze the immediate effects of repeatedly reading a passage.

Class Placement and Academic and Behavioral Variables as Predictors of Graduation for Students with Disabilities

Dropout rates impacting students with high-incidence disabilities in American schools remain staggering (Bost, 2006; Hehir, 2005). Of this group, students with Emotional Behavioral Disorders (EBD) are at greatest risk. Despite the mandated national propagation of inclusion, students with EBD remain the least included and the least successful when included (Bost). Accordingly, this study investigated the potential significance of inclusive settings and other school-related variables within the context of promoting the graduation potential of students with Specific Learning Disabilities (SLD) or EBD. This mixed-methods study investigated specified school-related variables as likely dropout predictors, as well as the existence of first-order interactions among some of the variables. In addition, it portrayed the perspectives of students with SLD or EBD on the school-related variables that promote graduation. Accordingly, the sample was limited to students with SLD or EBD who had graduated or were close to graduation. For the quantitative component the numerical data were analyzed using linear and logistic regressions. For the qualitative component guided student interviews were conducted. Both strands were subsequently analyzed using Ridenour and Newman’s (2008) model where the quantitative hypotheses are tested and are later built-upon by the related qualitative meta-themes. Results indicated that a successful academic history, or obtaining passing grades was the only significant predictor of graduation potential when statistically controlling all the other variables. While at a marginal significance, results also yielded that students with SLD or EBD in inclusive settings experienced better academic results and behavioral outcomes than those in self-contained settings. Specifically, students with SLD or EBD in inclusive settings were found to be more likely to obtain passing grades and less likely to be suspended from school. Generally, the meta-themes yielded during the student interviews corroborated these findings as well as provided extensive insights on how students with disabilities view school within the context of promoting graduation. Based on the results yielded, provided the necessary academic accommodations and adaptations are in place, along with an effective behavioral program, inclusive settings can be utilized as drop-out prevention tools in special education.

Impacto econômico do absenteísmo de enfermagem por doença em um hospital universitário do Rio de Janeiro-RJ

Trata-se de uma pesquisa documental, retrospectiva de fonte secundária,que adota uma abordagem quantitativa descritiva-exploratória. A partir da constatação de altos índices de absenteísmo nas unidades hospitalares, despertou-se o interesse em estudar os custos diretos das doenças ocupacionais que levam aos afastamentos e seu impacto econômico para o orçamento de recursos humanos de um hospital universitário do Rio de Janeiro. Neste contexto, definiu-se como objeto de estudo, o impacto econômico do absenteísmo por doença na equipe de enfermagem e, como objetivos: identificar as causas prevalentes de afastamentos no hospital universitário, de acordo com Classificação Internacional de Doenças e Problemas Relacionados a Saúde (CID-10); estimar os custos diretos mínimos das doenças que afastaram o trabalhador de enfermagem; estimar o custo real aproximado do absenteísmo relacionado a 1 (um) dia de trabalho prestado pelos trabalhadores de enfermagem, com projeção de 1 (um) mês e 1(um) ano numa visão operacional do Sistema Único de Saúde (SUS). Foi utilizada uma amostra estratificada de prontuários dos profissionais de saúde da equipe de enfermagem (enfermeiros e técnicos de enfermagem), a partir do seguinte critério de inclusão: profissionais de enfermagem concursados com afastamento no ano de 2010 e com diagnóstico médico determinante do afastamento, definido claramente. Para a coleta das informações foi feita a apreciação dos documentos arquivados no Serviço de Saúde do Trabalhador do hospital estudado e contou com a apreciação de especialistas médicos relativos aos grupos de diagnósticos estudados, orientados por roteiros criados pela pesquisadora. Os dados foram analisados e armazenados no programa Statistical Package for the Social Sciences (SPSS) versão 15 e no editor Microsoft excel 2003. Dentre os resultados obtidos tiveram destaque para as seguintes causas de afastamento, respectivamente, às doenças do sistema osteomuscular, os fatores que influenciam o estado de saúde e o contato com serviços de saúde, os transtornos mentais e comportamentais, as lesões, envenenamento e outras consequencias de causas externas e, as doenças do sistema circulatório, que representam um custo estimado aproximado de R$ 2,6 milhões. Pôde-se constatar que o impacto econômico do absenteísmo decorrentes dos agravos à saúde para o orçamento de recursos humanos do hospital universitário foi de aproximadamente 2,7%. O custo real aproximado do absenteísmo de enfermagem por dia, foi avaliado em R$ 92,50, tendo projeção mensal de R$ 2.775,00 e anual de R$ 33.300,00. Recomenda-se avaliar o absenteísmo dos profissionais regularmente para identificar as causas reais do absenteísmo por doença, a fim de definir metas para os programas de intervenção à saúde dos trabalhadores e promover uma Gestão participativa que favoreça uma análise do processo de trabalho no que concerne o atendimento das necessidades de saúde e operacionais da força de trabalho, determinantes do absenteísmo.

细胞外信号调节蛋白激酶-cAMP反应元件结合蛋白信号通路在应激所致抑郁行为障碍中的作用

Stress is the most important factor in the vulnerability to depression and other behavioral disorders, but the mechanisms that stress signals are transferred into depression are far from understanding. To date, the neurotransmitters, neurotrophins and signal pathway have been concerned in the topic focusing on the pathophysiology of depression, but there are still many puzzles. Increasing evidence has indicated that the alteration in neuronal plasticity is the “trace” of stress-induced damages. The extracellular signal-regulated protein kinase(ERK)-cyclic-AMP-responsive element（CRE）-binding protein(CREB)signal pathway is a powerful intracellular signal transduction pathway participating in neuronal plasticity which is involved in higher brain cognitive functions such as learning and memory. However, so far, little is known about the role of the ERK-CREB signal pathway in response to stress and emotional modulations. Thus the aim of the study was to systematically investigate the role of the ERK-CEB signal pathway in depressive-like behaviors induced by stress. Depression animal models, antidepressant agent treatment and disruption of signal pathway in specific brain regions were applied. In the present study, three experiment sessions were designed to make sure whether the ERK-CREB signal pathway was indeed one of pathophysiological mechanisms of depressive-like behaviors induced by stress. In experiment one, two different stress animal models were applied, chronic forced swim stress and chronic empty water bottle stress. After stress, all animals were tested behaviorally using open-field, elevated-plus maze and saccharine preference test, and brain samples were processed for determination of ERK, P-ERK, CREB and P-CREB using western blot. The relationships between the proteins of ERK, P-ERK, CREB and P-CREB in the brain and the behavioral variables were also analyzed. In experiment two, rats were treated with antidepressant agent fluoxetine once a day for 21 consecutive days, then the brain levels of ERK, P-ERK, CREB and P-CREB was determined, the depressive-like behaviors were also examined. In experiment three, mitogen activated extracellular-signal-regulated kinase kinase (MEK) inhibitor U0126 was administrated to inhabit the activation of ERK in the hippocampus and prefrontal cortex respectively, then behavioral measurements and protein detection were conducted. The main results of the study were as the following: (1) Chronic forced swim stress induced animals to suffer depression and disrupted the ERK-CREB signal pathway in hippocampus and prefrontal cortex. There were significant correlations between P-ERK2, P-CREB and multiple variables of depressive-like behaviors. (2) Chronic empty water bottle stress did not induce depressive-like behaviors. Such stress decreased the brain level of P-ERK2 in hippocampus and prefrontal cortex, but the level of P-CREB in the hippocampus was increased. (3) The antidepressant agent fluoxetine relieved depressive-like behaviors and increased the activities of the ERK-CREB signal pathway in stressed animals. (4) Animals treated with U0126 injection into hippocampus showed decreased activities of the ERK-CREB signal pathway in the hippocampus, and suffered depression comorbid with anxiety. (5) Animals treated with U0126 injection into prefrontal cortex showed decreased activities of the ERK-CREB signal pathway in the prefrontal cortex, and exhibited depressive-like behaviors. In conclusion, The ERK-CREB signal pathway in the hippocampus and prefrontal cortex was involved in stress responses and significantly correlated with depressive-like behaviors; The ERK-CREB signal pathway in the hippocampus and prefrontal cortex participated in the mechanism that fluoxetine reversed stress-induced behavioral disorders, and might be the target pathway of the therapeutic action of antidepressants; The disruption of the ERK-CREB signal pathway in the hippocampus or prefrontal cortex led to depressive-like behaviors in animals, suggesting that disruption of ERK-CREB pathway in the hippocampus or prefrontal cortex was involved in the pathophysiology of depression, and might be at least one of the mechanisms of depression induced by stress.

Estigma e percepções dos médicos de Clínica Geral sobre a doença mental e o suicídio

RESUMO: INTRODUÇÃO: A OMS (2001) revela que cerca de 450 milhões de pessoas sofrem de perturbações mentais ou comportamentais em todo o mundo, mas apenas uma pequena minoria tem tratamento, ainda que elementar. Transformam-se em vítimas por causa da sua doença e convertem-se em alvos de estigma e discriminação. O suicídio é considerado como um grande problema de saúde pública em todo o mundo, é uma das principais causas de morte de jovens adultos e situa-se entre as três maiores causas de morte na população entre 15-34 anos (OMS, 2001). As perturbações mentais aumentam o risco de suicídio. A depressão, esquizofrenia, e a utilização de substâncias incrementam o risco de suicídio. Estudos (Sartorius, 2002; Magliano et al., 2012) mostram que os profissionais de saúde, tal como o público em geral, podem ter atitudes negativas e estigma em relação às pessoas com perturbações mentais, podendo agir em conformidade, uma vez feito e conhecido o diagnóstico psiquiátrico. Os clínicos gerais são os receptores das perturbações mentais e tentativas de suicídio nas principais portas de entrada no acesso a cuidados de saúde. As crenças, conhecimentos e contacto com a doença mental e o suicídio, podem influenciar a atenção clínica. OBJECTIVOS: Avaliar o estigma e as percepções dos médicos de clínica geral em relação às tentativas de suicídio, o suicídio e perturbações mentais bem como os possíveis factores associados a estes fenómenos. MATERIAIS E MÉTODOS: Estudo do tipo transversal, combinando métodos quantitativos e qualitativos. A amostra é constituída por 125 sujeitos, médicos de clínica geral. Utilizaram-se as versões adaptadas dos seguintes instrumentos: Questionário sobre Percepções e Estigma em Relação à Saúde Mental e ao Suicídio (Liz Macmin e SOQ, Domino, 2005) e a Escala de Atitudes sobre a Doença Mental (Amanha Hahn, 2002). Para o tratamento estatístico dos dados usou-se a estatística 1) descritiva e 2) Análise estatística das hipóteses formuladas (Qui Quadrado - 2) a correlação entre variáveis (Spearman: ρ, rho). Os dados conectados foram limpos de inconsistências com base no pacote informático e estatístico SPSS versão 20. Para a aferição da consistência interna foi usado o teste de Alfa de Cronbach. RESULTADOS: Uma boa parte da amostra (46.4%) refere que não teve formação formal ou informal em saúde mental e (69.35%) rejeitam a ideia de que “grupos profissionais como médicos, dentistas e psicólogos são mais susceptíveis a cometer o suicídio”. Já (28.0%) têm uma perspectiva pessimista quanto a possibilidade de recuperação total dos sujeitos com perturbação mental. Sessenta e oito(54.4%) associa sujeitos com perturbação mental, a comportamentos estranhos e imprevisíveis, 115 (92.0%) a um baixo QI e 35 (26.7%) a poderem ser violentas e e perigosas. Os dados mostram uma associação estatisticamente significativa (p0.001) entre as variáveis: tempo de serviço no SNS, recear estar perto de sujeitos com doença mental e achar que os sujeitos com doença mental são mais perigosos que outros. Em termos estatísticos, existe uma associação estatitisticamente significativa entre as duas variáveis(X2=9,522; p0.05): percepção de que “é vergonhoso ter uma doença mental” e os conhecimentos em relação à doença mental. Existe uma correlação positiva, fraca e estatisticamente significativa entre os conhecimentos dos clínicos gerais(beneficiar-se de formação em saúde mental) e a percepção sobre os factores de risco (0,187; P0,039). DISCUSSÃO E CONCLUSÕES: A falta de conhecimento sobre as causas e factores de risco para os comportamentos suicidários, opções de intervenção e tratamento, particularmente no âmbito da doença mental, podem limitar a procura de ajuda individual ou dos próximos. Percepções negativas como o facto de não merecerem prioridade nos serviços, mitos (frágeis e cobarde, sempre impulsivo, chamadas de atenção, problemas espirituais) podem constituir-se como um indicador de que os clínicos gerais podem sofrer do mesmo sistema de estigma e crenças, de que sofre o público em geral, podendo agir em conformidade (atitudes de afastamento ereceio). As atitudes são influenciadas por factores como a formação, cultura e sistema de crenças. Sujeitos com boa formação na área da saúde mental têm uma percepção positiva e optimista sobre os factores de risco e uma atitude positiva em relação aos sujeitos com doença mental e comportamentos suicidários.-------------ABSTRACT: INTRODUCTION: The WHO (2001) reveals that about 450 million people suffer from mental or behavioral disorders worldwide, but only a small minority have access to treatment, though elementary. They become victims because of their disease and they become the targets of stigma and discrimination. Suicide is seen as a major public health problem worldwide, is a leading cause of death for young adults and is included among the three major causes of death in the population aged 15-34 years (WHO, 2001). Mental disorders increase the risk of suicide. Depression, schizophrenia, and the substances misuse increase the risk of suicide. Studies (Sartorius, 2002; Magliano et al, 2012) show that health professionals, such as the general public, may have negative attitudes and stigma towards people with mental disorders, and can act accordingly after psychiatric diagnosis is known. General practitioners are the main entry points of mental disorders and suicide attempts in the health sistem. Beliefs, knowledge and contact with mental illness and suicide, may influence clinical care. OBJECTIVES: To assess stigma and perceptions of general practitioners in relation to suicide attempts, suicide and mental disorders as well as possible factors associated with these phenomena. MATERIAL AND METHODS: This was a descriptive cross-sectional study, combining quantitative and qualitative methods. The sample consisted of 125 subjects, general practitioners. We used adapted versions of the following instruments: Questionnaire of Perceptions and Stigma in Relation to Mental Health and Suicide (Liz Macmin and SOQ, Domino, 2005) and the Scale of Attitudes on Mental Illness (Tomorrow Hahn, 2002). For the statistical treatment of the data we used: 1) descriptive (Data distribution by absolute and relative frequencies for each of the variables under study (including mean and standard deviation measures of central tendency and deviation), 2) statistical analysis of hypotheses using (Chi Square - 2, a hypothesis test that is intended to find a value of dispersion for two nominal variables, evaluating the association between qualitative variables) and the correlation between variables (Spearman ρ, rho), a measure of non-parametric correlation, which evaluates an arbitrary monotonic function can be the description of the relationship between two variables, without making any assumptions about the frequency distribution of the variables). For statistical analysis of the correlations were eliminated subjects who did not respond to questions. The collected data were cleaned for inconsistencies based on computer and statistical package SPSS version 20. To measure the internal consistency was used the Cronbach's alpha test. RESULTS: A significant part of the sample 64 (46.4%) reported no formal or informal training in mental health and 86 (69.35%) reject the idea that "professional groups such as doctors, dentists and psychologists are more likely to commit suicide." On the other hand, 42 (28.0%) have a pessimistic view of the possibility of full recovery of individuals with mental disorder. Sixty-eight ( 54.4 % ) of them associates subjects with mental disorder to strange and unpredictable behavior, 115 ( 92.0 % ), to low IQ, 35 ( 26.7 % ) and even to violent and dangerous behavior, 78 ( 62.4 % ) The data show a statistically significant (p = 0.001) relationship between the following variables: length of service in the NHS, fear of being close to individuals with mental illness and considering individuals with mental illness more dangerous than others. In statistical terms, there is a dependency between the two variables (X2 = 9.522, p> 0.05): the perception that "it is shameful to have a mental illness" and knowledge regarding mental illness. There is a positive and statistically significant weak correlation between knowledge of general practitioners (benefit from mental health training) and the perception of the risk factors (0,187; P0,039). DISCUSSION AND CONCLUSIONS: The lack of knowledge about the causes and risk factors for suicidal behavior, intervention and treatment, particularly in the context of mental illness options, may decreaseseeking for help by individual and their relatives. Negative perceptions such as considering that they dont deserve priority in services, myths (weak and cowards, always impulsive, seeking for attentions, spirituals problems) may indicate that general practitioners, may suffer the same stigma and beliefs systems as the general public, and can act accordingly (withdrawal and fear attitudes). Attitudes are influenced by factors such as education, culture and belief system. Subjects with good training in mental health have a positive and optimistic perception of the risk factors and a positiveattitude towards individuals with mental illness and suicidal behaviour.

Suivi neurodéveloppemental de l'enfant né prématuré dans l'Arc lémanique [Neurodevelopmental follow-up of premature children in Lausanne and Geneva].

Preterm children born before 32 weeks of gestation represent 1% of the annual births in Switzerland, and are the most at risk of neurodevelopmental disabilities. A neurological surveillance is thus implemented in the neonatal units, and multidisciplinary neurodevelopmental follow-up is offered to all our preterm patients. The follow-up clinics of the University hospitals in Lausanne and Geneva follow the Swiss guidelines for follow-up. An extended history and neurological examination is taken at each appointment, and a standardized test of development is performed. These examinations, which take place between the ages of 3 months and 9 years old, allow the early identification and treatment of developmental disorders frequent in this population, such as motor, cognitive or behavioral disorders, as well as the monitoring of the quality of neonatal care.