[Consultation in a baby clinic of the PMI (mother and infant welfare service): a survey in a French department]. / Consultation du nourrisson en PMI: enquête auprès des usagers et des professionnels d'un département français.

A dual survey carried out amongst the users and the professionals of PMI showed that proximity, the range of advice available, the exchanges on parenthood, and the assessment of the child's physical and mental progress and of his/her development are the key elements that parents are looking for. It is also noted that the majority of these parents deliberately consult these services. The objectives when consulting vary, going from a model based on the body and physical abilities, found especially in lower and disadvantaged groups, to one emphasising the child's psychological aspect and potential, which is the prerogative of the middle and higher classes. Indeed, although the PMI is particularly aimed at families in difficulties, all the social classes are now represented among the users. The primary role of prevention of PMI means that few parents go there specifically for the treatment of a medical disease. The majority of families maintain a parallel follow-up with another medical professional, usually a general practitioner with whom the PMI has very little contact. Given the decrease in the current medical demography and the governmental directives aimed at improving care in the prenatal period, the prospect of a closer working relationship between these two parties involved in infant welfare would seem to be a way of the future.

[Activities of medical practitioners in nursery schools for children under 6 years-old: the expectations of the facilities' directors]. / L'activité des medecins des structures d'accueil régulier d'enfants de moins de 6 ans: attentes des responsables de structures.

This work aims to describe the activities of nurseries' medical practitioners and the expectations of the nurseries' supervisors. It is based on the analysis of 139 questionnaires received from nursery schools' managers from the Pays de Loire region in 2005. Ninety percent of the nurseries that accommodate children less than six years-old, do employ a medical practitioner. She or he is often a salaried paediatrician with a full-time job or clinical practice, who consults twice a month for two hours and forty minutes in each nursery which employs him/her. Her/his main activity consists of conducting standard medical examinations when children are admitted into the nursery and on-going follow-up of their adaptation and healthy early childhood development. She or he also ensures that hygienic preventive measures are respected in case of an epidemic or other potentially hazardous health situations. Moreover, two-thirds of the establishments offer prevention follow-up for the children, whereas health promotion programmes and interventions are only carried out in just over half of them. Emergency medical procedures are conducted in a quarter of them only. Most of the nursery directors are satisfied with the medical services provided, despite some criticism. They mainly wish that practitioners were more available and more regularly present on-site in order to supply further preventive care, to develop training programmes for other staff members, and to participate in thematic meetings. Encouraging improved synergy between the professionals working in the nurseries, placing child psychologists to work in the facilities and fostering better relationships with the independent medical practitioners would all help the process of development and the evolution of the operational function of the medical practitioners in these structures.

[Addictive behavior after starting buprenorphine maintenance treatment]. / Conduites addictives depuis l'introduction de la buprénorphine haut dosage: evaluation chez 118 usagers de drogues.

OBJECTIVE: This study of a cohort of drug addicts receiving buprenorphine maintenance treatment in a district in western France focused on changes in their drug use and their social and work lives. It also looked at the health consequences of their drug use before and after maintenance treatment (mean: four years). POPULATION AND METHODS: From the files of an agency providing services to drug addicts, we randomly selected 180 of the 236 patients receiving buprenorphine maintenance treatment (BMT). Usable questionnaires were returned by 118 subjects (66% response rate). This self-administered questionnaire included 32 items. RESULTS: The respondents accounted for half the population receiving drug maintenance treatment and were representative of the population for age and sex. The mean age was 30 +/- 5 years, mean BMT dose 6,5 mg/day, and mean duration of drug maintenance treatment 47 +/- 27 months. Other drug use diminished during the four years of maintenance treatment: three of every four heroin users had stopped, opiate users dropped from 31% to 5% of the population, and cocaine use followed a similar trend. Benzodiazepine use also fell, but remained relatively frequent (27%, compared with 68% four years earlier). Drinking patterns changed from strongly alcoholic beverages to lower-proof drinks. Arrest rates dropped from 70% to 25%. The percentage of persons seropositive for HIV (4%) and HCV (33%) remained low, but too many subjects had not been screened (35%). Roughly 10% of these subjects had returned to work, mainly those who had cut their drug use most. CONCLUSION: While our survey reveals some positive points, especially a reduction in illegal drug use, several negative observations appeared, including combined use of cannabis and benzodiazepines, inadequate screening, and misuse of BMD. These results underline how important it is for care providers to focus simultaneously on medical treatment and identification of co-morbidities and to provide social work when necessary. The employment rate remains too low.