[Course and progression of children admitted before 4 years of age in a French child welfare center]. / Parcours et devenir de 128 enfants admis avant l'âge de quatre ans en pouponnière sociale.

AIM: The purpose of this study was to determine the institutional trajectory and future of young children in child welfare. MATERIALS AND METHODS: A catamnestic study - based on data from the child welfare office in Maine and Loire, France, from 1994 to 2001 - was conducted by a child psychiatrist and a psychologist. Medical, judicial, and educational data (development, health, pathways in child protection services) were collected and analyzed regarding the status of these children 15 years later, adding information gathered by interviewing the child welfare and foster family consultant. RESULTS: We included 128 children admitted to the child welfare office before 4 years of age. Admission to the child welfare system suffers from care delays (a mean of 13.1 months between the first child protection referral and placement) with an average entry age of 17 months and frequent cases of child abuse (e.g., seven Silverman syndrome cases). The physical and mental health status of these children was poor (poorly monitored pregnancies, prematurity, low birth weight). More than one third of the children had growth failure at admission, with catch-up in half of the cases. The average length of stay in the child welfare system was 13.2±4.6 years. At the end of the follow-up, there were specific measures to safeguard vulnerable adults: "young adult" (24 cases), "major protection" (eight cases) and "disabled living allowance" (nine cases). One hundred and sixteen children suffered from psychiatric disorders at entry and 98 at the end. The general functioning of children as assessed by the Children's Global Assessment Scale (CGAS) showed a statistically significant improvement. One out of two young adults showed problems integrating socially with chaotic pathways: many foster placements, unsuccessful return to the family, and academic failures. CONCLUSION: The clinical situations of children in the child welfare office and their long-term progression confirm the importance of this public health problem. Although the measures can greatly improve their physical and psychological recovery, with evidence of thriving, this remains limited: only a few of these children are well integrated socially and academically.

[Prenatal breastfeeding information: survey in Pays de Loire, France]. / Information prénatale sur l'allaitement maternel : enquête en Pays de Loire.

OBJECTIVES: The main aim of this study was to evaluate how well expectant mothers were informed on breastfeeding by healthcare professionals. The secondary objective was to determine the factors associated with the initiation of breastfeeding. POPULATION AND METHODS: The survey was conducted in a group of 500 women who had delivered at the Angers Hospital (France), based on a questionnaire filled out by the postpartum women during their hospital stay. RESULTS: The rate of breastfeeding was 61.2%. More than a quarter (26.9%) of the women did not receive any prenatal breastfeeding information. The survey showed that 77.8% of the women had been informed of breastfeeding advantages for infants and 51.5% of breastfeeding advantages for themselves. Only 27.5% had received the advice of exclusive breastfeeding for 6months. Only 5.2% had been informed of the uselessness of breast preparation during pregnancy and a minority had been informed of correct and incorrect breastfeeding contraindications. Only 15.4% of fathers had been involved in a discussion on infant feeding practices during prenatal consultations. Only 4.8% of the women had come to prenatal classes on breastfeeding with a relative. The maternal factors positively associated with breastfeeding initiation were age between 25 and 34 years, non-French origin, a high socioeconomic status, being married, having been breastfed, and having previous experience with breastfeeding. Breastfeeding initiation was negatively associated with maternal smoking. All the factors concerning prenatal breastfeeding information in women were associated with the choice of breastfeeding. CONCLUSION: This study pointed out the populations at risk of not breastfeeding. Breastfeeding information given to pregnant women by healthcare professionals may influence them on whether or not they choose to breastfeed their newborn. However, this survey showed that women are insufficiently informed on prenatal breastfeeding. Therefore, prenatal breastfeeding information should be improved.

[Teenagers' views and needs on sexual and emotional education. Survey among 15- to 16-year-old boys and girls]. / Connaissances, besoins et attentes des adolescents en éducation sexuelle et affective. Etude réalisée auprès d'adolescents de classes de troisième.

AIMS: Teenagers have very particular needs and their healthcare must be adapted to these needs. Despite all the modern means of communication and education, problems related to sex and sexuality have an effect on their well-being. Sex education has improved in the last 40 years, but what is today's situation? METHODOLOGY: In the Maine-et-Loire region of France, approximately 100 15- to 16-year-olds responded to a questionnaire, giving their views on the nature and quality of the sexual and emotional education they received. RESULTS: It appears that it falls very short of the legal requirements and that it is often inappropriate to the needs of young people. To improve sexual prevention, it is necessary to start early to provide sexual and emotional education and to increase the opportunities and the diversity of speakers presenting themes of importance to young people. The speaker should preferably be young and use lively means of communication and role-plays to normalize sex education. CONCLUSION: The most important aspects are respecting this young population as well as opening and maintaining communication with them, which will help them make better choices toward a better future. Promoting sex education is part of a global approach to healthy lifestyles and requires a national strategy, cooperation between the interested parties, and an adequate budget.

Management of low back pain in primary care prior to multidisciplinary functional restoration: a retrospective study of 72 patients.

OBJECTIVE: Chronic low back pain is a major socioeconomic health issue, due to the high direct (healthcare) and indirect (sick leave) costs. The aim of the present study was to describe the primary care management of low back pain patients prior to their inclusion in a multidisciplinary functional restoration network. METHODS: A descriptive, retrospective, questionnaire-based survey of the general practitioners dealing with 72 low back pain patients. RESULTS: Patients had been monitored by their general practitioner for an average of four years, with a mean frequency of eight appointments per year per patient. Ninety-three percent and 60% of the patients had been referred to a rheumatologist and a surgeon, respectively. Ninety-eight percent had had lumbar radiographies, 80% had undergone a computed tomography scan and 64% had undergone magnetic resonance imaging. The most commonly prescribed medications were anti-inflammatories and first- or second-line analgesics. Thirty percent had already received morphine analgesics and 50% had taken antidepressants. Thirty-two percent had undergone lumbar surgery. Physiotherapy was frequently reported and, indeed, 6% of patients had participated in over 100 sessions. Total sick leave averaged 8.25 months over the study's follow-up period. CONCLUSION: The time interval before referral to a multidisciplinary care team is long and so GPs should be encouraged and helped to organize this process earlier. It is also essential to determine factors which predict progression to chronic LBP.

Work status after workers' compensation claims for upper limb musculoskeletal disorders.

AIM: To provide information on employment status after workers' compensation (WC) claims for musculoskeletal disorders of the limbs (MSDs). METHODS: Two-year follow up of the workers who filed a WC claim for MSDs in 1996 in the Pays de la Loire region. Of the 701 eligible workers, 514 workers (70%) participated. Information was requested by means of a mailed questionnaire about the characteristics of the MSDs and job status at the time of the WC claim and two years later. RESULTS: Two years after the WC claim, 65% of the claimants had returned to work in the same company, often without any ergonomic improvement, 12% had retired or had left employment voluntarily, and 18% had been dismissed. The risk of dismissal was associated with three factors: being older than 45 years, having two or more MSDs at claim, and working in the cleaning services sector.

Prevalence, incidence and risk factors of carpal tunnel syndrome in a large footwear factory.

The study was conducted to assess the prevalence and incidence of carpal tunnel syndrome (CTS) in a large modern footwear factory and to identify factors predictive of CTS. To this end, 199 workers were examined in 1996, and 162 of them were re-examined in 1997. Ergonomic and psychosocial risk factors of CTS were assessed by workpost analysis and self-administered questionnaire. The prevalence of CTS at baseline in 1996 and in 1997 was 16.6% (95%CI: 11.4-21.7) and 11.7% (95%CI: 6.7-16.8), respectively. The incidence rate of CTS in 1997 was 11.7% (95%CI: 6.7-7.8). No specific type of job performance was associated with CTS. Obesity (OR = 4.4; 95%CI: 1.1-17.1) and psychological distress at baseline (OR = 4.3; 95%CI: 1.0-18.6) were strongly predictive of CTS. Rapid trigger movements of the fingers were also predictive of CTS (OR = 3.8; 95%CI: 1.0-17.2). A strict control of thework by superiors was negatively associatedwith CTS (OR = 0.5; 95%CI: 0.2-1.3). The prevalence and incidence of CTS in this workforce were largely higher than in the general population and numerous industries. The study highlights the role of psychological distress in workers exposed to a high level of physical exposure and psychological demand.

[Training in health education in child welfare nursing schools: a survey of teachers and students]. / La formation à l'éducation pour la santé dans les écoles de puéricultrices: une enquête auprès des enseignantes et des élèves.

The emergence of new nurses' profile, stemming from study program of 1992, has urged nursery-nurse schools to think about their current training program. We have hold an inquiry in these schools to know how this new profile could be a factor to make easier the training in health education. We have also asked nursery-nurse teachers about the same problem in order to make suggestions just before reform of study's program of nursery-nurse certificate. This inquiry has shown that profile was polymorphic and there was some evolution in used tools of communication. Thenafter, suggestions regard the whole of training program but in priority about a procedure for a community health in order to satisfy needs of populations concerned by nursery nurse work.