[Brief analytic essay on unconscious forces facilitating transgenerational repetition of physical or sexual abuse]. / Bref essai d'analyse des mécanismes inconscients qui interviennent dans la répétition transgénérationnelle d'abus physiques ou sexuels.

Transmission of abusive conduct is mainly determined by unconscious guilt and identification with the aggressor. The abused child is bound to split the parental object. The hostile side is eclipsed due to dependence and regression. Therefore deprived of the hated object, the guilt surges forcefully with the role reversal of the following generation. The former victim, whose identifications with the aggressor are actuated, discharges his guilt by projective identifications with the new victims. The ongoing splitting perpetuates the pathology of the relation.

[Psychic trauma in catastrophes. Views and reviews]. / Traumatisme psychique en cas de catastrophes. Vues et revue.

A review of literature on the subject reveals a great diversity of views but can nevertheless serve as a guideline for concrete interventions. A recent survey of the psychological state of the traumatised armenian population serves as a background for the theorisation of the trauma. Under the shock, the splitting of the ego and of the primitive self leads to a contradictory symptomatology. The ego level is mainly caracterised by repetition whereas the reactivation of the primitive self leads to avoidance of contact. Confusional states result from the gap between these two instances. Priority is given to group therapy when the ego fails to play its part. When the ego is reestablished, but must face certain losses, among which the loss of its own continuity, individual therapy is at place. Understanding the psychic trauma leads to a model of change.

Acceptance and use of patient-carried health records.

The ultimate goals of providing health records to patients are to improve continuity of care, to improve patient understanding of instructions, and to encourage patients to take a more active role in maintaining their health. In the current study, four types of patient-carried health records were evaluated in a hospital-based outpatient service to determine whether records would be accepted and used, to estimate the cost of the process, and to obtain patient and provider reactions. Records were provided at moderate cost and the primary determinants in record acceptance and use were physicians' support of the process, the type of record, and the employment status of the patient. A small record which could be carried in a wallet seemed suited to most patients; other more elaborate participatory records appeared to have benefits for selected patients. More extensive use of participatory records appears to require changes in the way health care would be delivered.

Acceptance and use of patient-carried health records.

The ultimate goals of providing health records to patients are to improve continuity of care, to improve patient understanding of instructions, and to encourage patients to take a more active role in maintaining their health. In the current study, four types of patient-carried health records were evaluated in a hospital-based outpatient service to determine whether records would be accepted and used, to estimate the cost of the process, and to obtain patient and provider reactions. Records were provided at moderate cost and the primary determinants in record acceptance and use were physicians' support of the process, the type of record, and the employment status of the patient. A small record which could be carried in a wallet seemed suited to most patients; other more elaborate participatory records appeared to have benefits for selected patients. More extensive use of participatory records appears to require changes in the way health care would be delivered.