La Maison de Solenn is a success, welcomes Dr. Rufo

After its opening, the Maison de Solenn - home adolescents Paris is proud of its medical officer , Professor Marcel Rufo , and the President of the Hospital Foundation Paris -Hôpitaux de France , Bernadette Chirac , the origin of project whose operations Parts Yellow conducted annually with the same ardor led funding.
A home from home ... for young people suffering
Inaugurated on 17 November 2004, the Maison de Solenn -House Youth opened its doors to the public on the website of the Groupe Hospitalier Cochin -Saint Vincent de Paul La Roche - Guyon, in Paris.

This house, whose architecture and design make it a unique place of its kind , is part of the housing program developed by the Youth Foundation to help young people suffering.

Together in one place a wide range of disciplines and skills necessary to support effective and efficient adolescents, it is at once a place of welcome , prevention , information , care and monitoring teaching and research , said Bernadette Chirac , during a press conference to take stock after six months of operation.

The President of the Foundation also recalled that two houses of adolescents had been inaugurated in 2004 , one in Rouen , the other in Reims, and five new projects were underway in 2005 ( Caen, Dax , Pontoise, Rennes , Macon ) .

Nearly 15,000 teenagers acceuillis
Since its opening , 14,727 teenagers were welcomed ( in person or by telephone) or received an interview , and 4349 had a multidisciplinary consultation , said Dr. Rufo .

After a very strong attendance (800 per month ), medical consultations saw their numbers stabilize at 500 per month. In 90% of cases it is the spontaneous initiative of adolescents or their parents requests , said the psychiatrist .

Between January and May 2005, 70 young people were hospitalized for medical or stay six days on average, for support of their eating disorders for about 3 months, for psychological disorders (depression , impaired personality , phobias ... ) for 3 weeks or emergency in one of two beds reserved for this purpose.

La Maison de Solenn is also a victim of its success , since many young people who use this structure are being directed to other care facilities for lack of space , laments with Reuters Health Pierre Bert frame nurse.

The therapeutic foster part-time center ( CATTP ) hosted 26 teenagers at two workshops per week . Very popular with teenagers , they are prescribed by doctors as cultural care in addition to medical care. They are an opportunity for some to "discover new things " like singing or piano , testified Valentine, 15, who made ​​a one-month stay at the Maison de Solenn . And most importantly they allow therapists to work on the problem of narcissism , which is the common problem of all these young people, says senior nurse .

According to him, the 15-16 age group represents the majority of adolescents received. The largest group consists of those who suffer from eating disorders . A kitchen is also specially designed for people suffering from anorexia , where a dietitian prepare a "minimum" menu.

For Valentine, the Maison de Solenn differs from conventional hospital units with " humanity and understanding " shown by caregivers . Same observation from Jeremy, 18, ​​for whom the success of this institution is the quality of the people who work there . "These people must be picked " , was he exclaimed.

Very surrounded both by the medical staff and other young people that they recognize , they return regularly , by appointment or unannounced, to find " the energy that allows them to move the before . " Recognizing that they do not yet feel ready to move on from this " crutch " , they rely on the continuation of French courses during the stay to facilitate their return to "real life ."

Treat depression , it is also protecting his family

Treat depressive , it is also protecting his family , the occurrence of this disease can cause the " explosion" of a family, said Dr. Sami- Paul Tawil , psychiatrist ( Saint-Antoine Hospital , Paris ) during the " day European depression . "
In a book entitled " The Mirror of Janus , understand and treat depression and manic depression," the practitioner devotes an entire chapter to the impact of the disease on the patient's environment and the role of family.

Characterized by the persistence of a melancholic state , depression has many faces . It can also alternate with periods of elation , signature of manic depression . But by providing a common approach to diseases that affect the mood in France over four million people a year , Dr. Tawil tries to demonstrate in his guide of the disease, they are not inevitable. If the conditions are met.

" A previously welded family can literally explode ' when one of its members is diagnosed manic-depressive ," he warns. There is sadness , surprise and especially an almost palpable fear. " With manic depression , we can talk about chain reactions and ricochets unconscious . Everything telescope with brutality in anguish and sometimes in violence," he said. Guilt , shame, anxiety, despondency and anger are also conventional reactions , he says.

The role of the family is yet to provide full support , says he , " without love and friendship, the best drugs and the best psychotherapy is not enough that a manic-depressive illness effectively fights " . But he also warns , "love does not pay in excess : criticize or infantilizing a sick person équivant to freeze in his illness, to stifle his personality and help take action ."

In fact , he says , the whole family needs help to reach the patient support . And talk with the doctor is the first step . It may eventually offer family therapy in addition to individual therapy , because in all cases , the parent and children suffer too much power to bear alone and unaided the new situation.

Providing assistance to caregivers , Sami -Paul Tawil provides twelve recommendations to close a manic-depressive . Among these , the practitioner advises not to preach , to banish all emotional blackmail , not to resort to the threat.

These tips are all ways to help patients to protect loved ones.

Lung cancer deaths in women increased in 27 European countries

A large European study on mortality from lung cancer in women showed an increase in all European countries except six of the 33 studied.
The study, published on the website of the " Annals of Oncology" , focused on women aged 20-64 years in the 25 countries of the European Union , the countries of Eastern Europe and Russia.

It shows that female mortality from lung cancer increased from 7.8 per 100,000 women in the early 80s to 11.2 per 100,000 in 2000-01. For comparison, the mortality rate is 24 deaths per 100,000 in the United States, where lung cancer has become the leading cause of cancer deaths among women.

The authors calculated that in Europe, mortality increased at an annual rate of 1.5% between 1965 and 1971 , 2.6% between 1972 and 1987 and 1.4% from 1998 to the end of the study.

An analysis by age was performed. Between the early 90s and 2000-01 mortality in younger ( 20-44 years ) increased by 11.41% against an increase of 21.1 % in older ( 35-64 years).

If the overall lower number of deaths among younger women make slightly less clear figures , the trend is proved " more favorable" than in the group of older women , the authors write .

" If effective interventions against tobacco are implemented with women, the epidemic of lung cancer among European women should not reach the levels seen in the United States," they say.

England and Wales of Wales are among the countries where the mortality at all ages has declined in recent years ( with Latvia , Lithuania , Russia and Ukraine ), although the rates are still very high (19.75 deaths per 100,000 ) . Younger British women , the rate has dropped, from 1.56 per 100,000 in 1990-1991 to 1.19 per 100,000 in 2000-2001.

In France , the mortality for all age groups increased steadily, reaching 7.31 per 100,000 in 2000. French youth , the rate almost doubled between 1990 to 1991 (1.08 per 100,000 ) and 2000 (2.12 per 100,000 ) .

While France may be expected that this mortality rate continues to increase due to the number of smokers in the long term , the country should be able to record a decline since the number of new smokers began to decline , told Reuters Health lead author Dr. Cristina Bosetti , Institute of pharmacological research in Milan.

To reduce mortality , it recommends that governments not only increase taxes on tobacco and to ban smoking in public places , but also to target women and children in campaigns against smoking.

The highest mortality rates in countries such as the UK can be attributed to new habits adopted by women in the 40s , said Dr. Cristina Bosetti .

" After the Second World War , the emancipation of women passing by smoking and greater alcohol consumption ( in the UK ) . In countries like France and Italy, this movement came later " she adds .

The high U.S. mortality rates, which decreases after a peak about five years ago to 26 deaths per 100,000 , could be attributed to the same causes, the American who started smoking in the 30s .

Palliative Care: accurate information necessary for both the general public and health care providers

The general public and health professionals are waiting for accurate and detailed information on palliative care and more widely on the serious illness , said a summary was published by the Research Centre for the Study and Observation living conditions ( Crédoc ) .
Accompany the end of life of a patient
This paper presents the views of the general population and health professionals not working in a structure on hospice care and support for people in later life . These perceptions were collected between May and July 2003 , with a hundred people being expressed in individual interviews or group sessions, and have been the subject of a report co-authored by the Crédoc and the National Institute for Prevention and health Education ( INPE ) .

Rarely mentioned spontaneously , either by the public or by caregivers, hospice still prove little known , although all agree that their primary objective is to improve the end of life of the patient. They refer to the image of an "alternative medicine " , which is to relieve pain and suffering pain , succeeding the healing phase and lying " between aggressive treatment and euthanasia " can be read in the report.

Among the general public , very few people know the professionals involved in the care of palliative care, and their work is also partly ignored : if the need for training on the psychological aspect is mentioned, no identifies the technical aspects of the occupation.

Accurate, practical and usable
Most healthcare professionals surveyed have meanwhile been unable to mention the structures of palliative care in their area. But even if they do not exercise within a structure of palliative care, " they are likely to make themselves the care or referred to specialized teams ," say Typhaine Mahe , Bruno Maresca and Mary Odile Simon , committee members who conducted the study .

Doctors and nurses are therefore waiting for information , both on the practice of palliative care , in particular the support to which they feel powerless , lack of time and training , and the provision of care existing locally.

The need for "explicit" information and "operational" is also felt for the general public who want to be better prepared to deal with , where applicable, the serious illness of a loved one .

As for the transmission of this information, the wishes of the general population and caregivers meet: the first express the wish " of oral information , targeted and relayed by hospitals and private doctors ," while the latter " want control information (...) , be informed before their patients and the general population ( ... ) and used as privileged actors and relay to the public , " say the authors of the report.

But if this information is required, the professionals interviewed stressed the importance of having sufficient resources to develop the structures first , otherwise all requests can not be met.

Care : cost, a serious obstacle for 36% of French

Approximately 36 % of the French have abandoned or postponed care or purchase of drugs because of their costs, according to a poll by ViaVoice for interassociative Collective Health (Ciss ) .
This survey was conducted by telephone with 1,004 people. Of all respondents , 90 % had additional health , 45% in individual contracts and 43% in group policy . The beneficiaries of universal health coverage (CMU) represent 13 % of the sample , people in long-term illness (ALD ) 19% .

They are 26% report having had to forego medical care or purchase of drugs "because of the expense incurred ." Some groups are more concerned 38% of CMU beneficiaries , lower at 1,500 euros monthly income (36%) , people with ALD ( 33%), 25-34 years ( 32 %) and private sector employees (30 % ) .

They are also 30 % have decided to postpone such remedies for the same reasons . The categories most affected populations are always the same : the CMU beneficiaries (42%) , lower than 1,500 euros monthly income (38%) , people with ALD ( 37%), 25-34 years ( 40% ) and women ( 35%).

The rate of French to have waived care or to purchase drugs is 41% women and 49% among those aged 25-34 . Among people in ALD , it is 44 % and for CMU beneficiaries , 51 %.

Asked about the transfer of a portion of the expense reimbursements to health complementary health , the French are 73 % believed that this increases health inequalities and 54 % believe that this is the first step towards privatization of health system. However, for 64%, it allows a higher level of reimbursement and 51% , improved quality of care .

They are 35 % think that the increase in contributions to their health could further push to cancel 43% and it could force them to lower -end , taking a less expensive but with more limited coverage contract.

This result corroborates the statement made last week by the health director of the French Federation of Insurance Companies (FFSA ), Alain Rouche , indicating with premium increases , people were " more difficult forward " and they watched " more declines in the levels of safeguards . "

When asked about the priority given by the government to reform the health care system , 43% of French believe that the priority is to reduce the rate of support , 38% that it is to reduce the deficit and save and 26% to reduce the consumption of drugs. Finally, 10% consider that the priority is to improve care and research.

According to interviewees , the priorities should focus on maintaining a good level of reimbursement by health insurance ( 53%), a better distribution of health professionals in the area ( 47%) , improving the equal access to care ( 46%) and quality of care ( 39%) , prevention (33%) , reduced health care costs ( 27%) and the financial stability of health insurance (23 % ) .

In addition , 74 % believe that the State should take all necessary measures to ensure that social security pays the most possible health spending French , while 20 % believe that more people should take charge of this type of expenditure , given the lack of social security.

In a statement, the Ciss denounced the bill funding the Social Security ( PLFSS ) 2011 in which the government introduced measures that " will mainly effect of penalizing users ."

The organization deplores " the lack of political courage that leads to the destabilization of solidarity and universal health insurance coverage for an insured logic " and calls for a " large-scale public debate on the choice of financing of the health system french " .

Soy : good for cholesterol but in moderation

Soy lowers cholesterol and does not increase the risk of breast cancer, but its use must be tempered by the presentation of Jean- Michel Lecerf , head of the nutrition department at the Pasteur Institute in Lille , Lyonel Rossant , liberal pediatrician and Gwénaële Joubrel , during a roundtable interviews Bichat scientific Director of the French association of traditional soy food manufacturers ( Sojaxa ) at in Paris.
Based on scientific studies , including the report on "Security and benefits of phytoestrogens provided by food - recommendations " of the French Agency for Food Safety ( AFSSA ), the three scientists wished to point on the nutritional benefits of soy foods .

Soy contains isoflavones, polyphenols with low estrogenic activity which gives them the name of " phytoestrogens " . Based on the available toxicity studies , AFSSA recommended limited to 1 mg of isoflavones per kg body weight per day daily intake. "It would consume more than 5 soy products every day to achieve this level of intake ," says the synthesis of roundtable interviews Bichat .

AFSSA has confirmed the interest of consuming soy protein (30 g per day) to lower circulating levels of cholesterol and found that soy isoflavones have a favorable effect on vasotonicité ( from a contribution 45 mg per day) .

" Studies indicate that the incidence of cardiovascular disease is four times lower in Asian countries where the consumption of soy products is higher than in Western countries where it is weak " stress the authors.

Regarding breast cancer , studies show a protective effect of phytoestrogens in Asian women, not transferable to Western women , due to insufficient data . AFSSA concluded , however, that the consumption of soy foods does not increase the risk of developing breast cancer .

In patients with a history of breast cancer , AFSSA recommends not to exceed the daily intake of 1 mg of isoflavones per kg of body weight per day for women who have undergone breast cancer.

Based on childhood soy protein preparations , the three stakeholders indicate that consumption for 40 years in several Western countries demonstrated their equivalence formulas based on cow 's milk proteins . " No adverse effect of soy and / or isoflavones on growth and neuroendocrine development was highlighted in these populations," the report said.

However, the AFSSA report stated that " infants exclusively with preparations of soy protein receive up to 40 times too isoflavones with products currently available on the market ." The agency recommends limiting the intake of phytoestrogens than 1 mg / l of reconstituted " given the current state of knowledge and uncertainty about the long- term" preparation .

The main advantages of soy intake reside in a high amount of essential amino acids , fat (mostly unsaturated fatty acids and no cholesterol). Historically developed for people with lactose intolerance or allergy to proteins of cows , food and drink soy were also recommended for people with high cholesterol.

jejunum

This is the second part of the small intestine. It follows the above DUODENUM and ileum.

This is the longest part of the small intestine. It may be the seat of many diseases, such as disease CROHN.

Hepatitis markers

To assert hepatitis A, we can find the HAV IgM anti marker several weeks after the contagion.

For hepatitis B:

- From 4 to 12 weeks after the contagion:
HBs antigen or antigen australia will be present. Is the antigen on the surface of the virus;

- 6 to 15 weeks after the contagion:
HBeAg is found in serum. It is a surface antigen which corresponds to a complete virus;

- Another antigen, HBc antigen, exists within the capsid of the virus and does not found in serum. Appears in the recovery period as anti HBc antibody in serum.

Each antigen causes the appearance of a specific antibody to a greater or lesser time period away from contagion.

In summary:

- HBsAg appears at the beginning of infection and persists in the period of state and disappears convalescence;

- HBeAg appears later and disappears earlier than HBsAg;

- Anti HBs appears a few months after the contagion and may persist for several years;

- Anti HBc appears 6 weeks after contagion and may persist for years.

Ag (antigen) HBsAg + anti-HBs anti-HBc + = acute or chronic infection during

HBsAg, anti-HBc anti-HBs + + = history of hepatitis B: about protected

HBsAg, anti-HBs + anti-HBc = after immunization protected person, after natural contact: about vaccinating

HBsAg, anti-HBs and anti-HBc + = a recent infection before the appearance of anti-HBs after previous infection or disappearance of anti-HBs.

The presence of HBsAg carrier excludes blood donation.

healing of acute hepatitis B means:
- Normalization of transaminases,
- The appearance of HBc antibody
- The disappearance of HBsAg.

The transition to chronicity characterized by:
- The persistence of elevated transaminases,
- The presence of HBsAg and HBeAg.

For hepatitis C, HCV marker research confirms the diagnosis. Chronicity is accompanied by anti-HCV and elevated transaminases (sometimes normal though). The virus can be asserted by sophisticated laboratory techniques (PCR HCV).

Hepatitis A risk countries

Hepatitis A is the most common infections reaching the exotic travelers can be prevented by vaccination.

The luxury tourists are not free of the disease, of course with less risk than other tourists traveling in worse conditions.

Those most at risk are India, Mexico, South America, the Caribbean and Africa. Then come from North Africa, the Middle East and Southeast Asia.

It is therefore imperative to get vaccinated before going to these destinations, especially the subjects less than 40 years in our developed countries have a much better chance of not being immunized.

A new possibility of vaccination can be protected by a single injection (HAVRIX 1440), with booster 6-12 months later that provides protection over several years

Regurgitation infant

It is always difficult to tell the difference between a trivial regurgitation in infants and gastro-oesophageal reflux true. Gastro-oesophageal reflux is mentioned as severe vomiting causing digestive symptoms:

1 - esophagitis: agitation baby during feeding and during sleep, sometimes anorexia (lack of appetite), a DYSPHAGIA;

2 - thrive impact, the child no longer grows;

3 - respiratory symptoms and acute or chronic ENT;

4 - or asthma;

5 - serious ailments of the baby, which would be due to a slowing of the heart or apnea, associated with the presence of stomach acid into the lower esophagus.

Mundane regurgitation yield to 5-7 months, events of gastro-oesophageal reflux will last up to 2 or 3 years.

Additional tests are required only if atypical symptoms: severe discomfort, respiratory and ENT repetition, further examination is the reference PH METRY. Sometimes ultrasound or endoscopy stomach will be required.

TREATMENT

The simple regurgitation requires only simple dietary measures: thickening of the bottle and the bottle after postural advice.

Pathological regurgitation causing infectious pulmonary complications, a faltering weight, require, in addition to dietary measures, drug therapy.

It will give the milk to predominate in favor of soluble proteins in milk casein predominant.

Y add thickeners.

Note the excellent effect of milk ENFAMIL AR exists in milk for infants up to 4 months and the second milk after age 4 months.

In addition:

- It should not be given to drink between meals and before bedtime,

- Avoid fruit juices that are acidic liquids

- Avoid older children soft drinks, chocolate and mint (decrease SPHINCTER factors, see this term, lower esophagus)

- Avoid PASSIVE SMOKING.

Drug treatment is based cisapride, administered in 4 divided doses during the day according to medical advice.

We will be adding the administration of alginate or smectite in complicated cases.

Treatment in gastro-oesophageal reflux should be continued until the age of 18 months.

Finally, surgery should only be considered to gastro-oesophageal reflux that persists beyond 3 or 4 years.

Proctitis

These are inflammatory diseases of the rectum and anus, whose causes are multiple:

1 - some are cryptogenic, that is to say the cause is unknown or escape our means of investigation, such as the illness or CROHN

,

3 - some may be iatrogenic (caused by radiation, certain medications or abnormal practices).

The lesions are variable. They may involve edema, congestion, ulceration or cracks, pustules or various blooms (see WARTS, adenoids ULCERATIVE Hemorrhagic (see these terms)

2 - others can be infectious, parasitic, tumors).

SYMPTOMS

It generally flows mucus, muco-purulent or bloody stools that may accompany or occur outside them.

False needs are common and result in a non-fecal evacuation. These false needs are often compelling, they are accompanied by tenesmus (qv, painful tension with burning) and rectal pain.

BLEEDING ALL BE ORIGINAL LOW (NAFTA) OR HIGH (RECTAL) NEED A COMPREHENSIVE REVIEW AND COLORECTAL.

CAUSES

1 - The ULCERATIVE and Hemorrhagic disease CROHN (see these terms) anorectal causes are unknown but serious origin;

2 - with specific infectious:

- Anorectites venereal syphilis that can be (see SYPHILIS), gonorrhea (see gonorrhea), viral, or due to disease NICOLAS FAVRE (sickness)

- Anorectal tuberculosis has become rare;

3 - Parasitic proctitis: amebiasis, schistosomiasis;

4 - Iatrogenic proctitis:

- Prolonged antibiotic,

- Therapeutic local irritating or allergenic,

- Rectal melanosis due to misuse of anthraquinone laxatives (phenolphthalein, rhubarb, senna, buckthorn)

- Thermometer lesions

- Post-radiotherapy lesions.

TREATMENT

The treatment is the cause.

Virus persistence

Some virus after infection persist in the body and are not removed, as opposed to some that after infection are destroyed by antibodies that the body will be made (eg Rubella is caused by a virus that triggers the production of antibodies that destroy the virus).

Viral persistence is responsible for:

- Highs of episodes in the life of the subject,

- A viral infection that can occur in case of impairment of the immune system,

- Chronic infection,

- Viral infections may be associated with cancer,

- Especially because this virus is always survival of the virus in a population.

The virus somehow escapes the immune system and reaches its target tissue where it will remain more or less dormant (latent) during the lifetime of the subject without events too damaging to the survival of the organization achieves.

- The HERPES virus is a DNA virus causes this phenomenon of viral persistence.

During primary infection, the virus wins ganglia and integrates its GENOME CHROMOSOME in neuronal ganglion cells.

When various factors such as the flu, sunburn, fever, rules, psychological conflicts, the virus is reactivated and suddenly manifest, for example a BUTTON FEVER. The number of activations varies depending on the subject.

- The POX virus ZONA site has its persistence in the nerve ganglia also. Reactivation is usually after several years. If the immune system fails, reactivation can be extremely serious by the occurrence of an extremely severe shingles.

- The CYTOMEGALOVIRUS site has its persistence in the lymph nodes. It integrates its genome into B lymphocytes. Reactivation can be very severe in immunocompromised giving lung, liver sometimes very serious digestive diseases,.

- The Epstein Barr virus persistence has its site in the lymph nodes and integrates its genome into B lymphocytes. Reactivation can be very serious in some areas of the world where it causes LYMPHOMA BURKITT.

- The virus HEPATITIS B's site persistence in the liver and salivary glands. Fortunately, the virus is usually eliminated by the body through a good immune response. However, in some cases it integrates its genome into the genome of liver cells. Reactivation causes chronic hepatitis and cirrhosis and sometimes liver cancer.

Remember that viral persistence is reflected by the presence of HBsAg antigen (australia) in the blood and the absence of anti-HBs (anti-HBs Ab). The HBeAg is a marker of viral replication.

- HEPATITIS C virus: the virus RNA appears to persist through continuous replication in the body and not by integrating its genome into the cell genome. reactivation causes chronic hepatitis and cirrhosis sometimes even liver cancer.

- The AIDS virus have their site persistence in the lymph nodes, especially in the T-CELL 4 and Macrophages (see these terms). See AIDS VIRAL PERSISTENCE.

The phenomenon of viral persistence is important to know to find and administer the most effective treatment at the right time, and for making possible vaccines.

Viral infections are very complex and difficult to control.

Perinatal smoking: a struggle to intensify

The fight against perinatal smoking should be intensified, despite the many efforts to improve the management made especially during antenatal, warned midwife tobaccologist CH Bayonne, while reporting the results of a survey in 2003 377 public maternity.

A questionnaire was sent out in late 2003 midwives frames 377 public maternity listed on the website of the Ministry of Health, addressing three themes:

1 / the care of pregnant patients who smoke during pregnancy in the service, to learn about the organization of the consultation cessation practitioner and what it was made;

2 / resumption of smoking in the postpartum period, to assess the valuation services by periods and the frequency of relapses;

3 / relapse prevention after childbirth.

"We received 214 responses of 377, of which 211 are interpreted, including 45% of maternity Level 1 60% Level 2 and 50% Level 3," said the midwife.

Only 20.4% of respondents maternity held specific consultations cessation within their service. "Maternity Level 3 to have nearly half of them (43%) created a specific consultation, against respectively 19% and 14% for levels 1 and 2. This seems logical given the fact that maternity Level 3 are supposed to concentrate the most serious diseases and certainly more aware of the risks of maternal smoking, "noted the health professional.

79.6% in the consultation is not available, 70.6% of patients are referred to a smoking cessation center.

"It is clear from the survey that individual consultations (62.8%) are preferred over group meetings, as well as the method of cognitive behavioral therapy (74.4% of establishments, while 53.5% use drug withdrawal only), "says the midwife CH Bayonne.

The responses show, moreover, that these consultations are for smoking cessation 62.8% under the responsibility of midwives and 41.9% by non Obstetricians tobaccologists doctors. The number of consultations averaged 4 or 5, regardless of the level of motherhood. Consultation time is between 10 and 30 minutes for 37.2% of maternity and becomes greater than 30 minutes for 39.5% of them.

RECOVERY OF SMOKING POSTPARTUM

Only 40.8% of schools responded to the question about the existence of relapse "which proves the ignorance or the lack of interest the problem of post-natal smoking," said the midwife.

Among the responses, 46.5% observed a relapse from the puerperium, 30.2% think it occurs only after two months and 8.1% at 6 months. "We do not see a year follow-up of patients and no statistics on the rate of relapse was provided by maternity hospitals," said the professional.

Consultation on smoking cessation postpartum, few maternity (49 of 211) responded to this question. Where it exists, it is individual for 86%. The length of the longest follow-up was 2 months and corresponds to the date of compulsory postnatal visit: 32% of consultations are conducted by midwives and 60% by tobaccologists doctors inverse proportion to the antenatal period. In addition, a very significant percentage of obstetrician-gynecologists (2%) is involved in this period.

INFORMATION ON PASSIVE SMOKING

In this survey, 74.7% of maternity inform on the risks of passive smoking. "This information is usually provided in the immediate aftermath of layers (79.7%), another special moment corresponding to the meetings of the birth preparation (24%). A written document is used by 21.51% institutions. However, this subject is addressed in the mandatory post-natal consultation in 16.45% of the answers, "said the midwife CH Bayonne.

Information on passive smoking is broadcast in 88.6% of cases by midwives in 33.5% of cases by the nursery, in 30.9% of cases by pediatricians and 25.9% of case by obstetricians.

Finally, of the 211 responses received, 117 or 55.5% have maternity maternity project without tobacco.

"The relatively high response rate for a survey of this kind shows the interest in the problem of the management of smoking pregnant women by health professionals that we are. Recent years have witnessed significant progress in the field of prevention with the creation of a maternity network without tobacco. Nevertheless, too little effort has been made postnatally despite the collective awareness of the harm caused by passive smoking for infants " says the midwife.

According to her, it now remains a need to better inform women about the risks of continued smoking during and after pregnancy, as well as strategies to help stop smoking, as well, to better train caregivers at minimal advice and thus engage in a policy of prevention service.

Impact of smoking on health

Everyone is experiencing the adverse effects of nicotine vis-à-vis the organization.

Complications tobacco appear after 20 to 30 years of use.

The addiction to tobacco does not present specific symptoms because its diagnostic criteria are included in the addiction criteria established by Goodman. However, some significant signs smokers are:

Treatment of smoking

The first approach in the treatment of tobacco addiction is psychological counseling.

Medication

Drug treatments are mainly based on products nicotine replacement (gum, patch, sublingual tablet or inhaler).

Their use and effectiveness are conditioned by the dependence of the subject. Their administration requires medical monitoring of pregnant women and individuals with heart disease.

Currently, there is another drug called Champix, which also aid to smoking cessation. This drug does not produce nicotine but reduces signs of withdrawal by mimicking the effects of nicotine and reduces the sensation of pleasure brought by nicotine.

Antidepressants are sometimes prescribed by doctors during withdrawal.

The side effects of drugs are mainly characterized by nausea, headache, vomiting, flatulence (gas in the stomach), insomnia. Other patients even talk of changing the perception of taste.

Other therapeutic methods have also brought their fruit such as homeopathy and acupuncture.

The maturational psychotherapy and cognitive behavioral therapy are significantly effective.

Smoking prevention

Several countries have taken steps to fight against smoking, including higher taxes on tobacco, which causes an increase in tobacco prices. The adoption of this policy was the cause of a decrease in sales of tobacco and has proven effective for many countries.

Awareness campaigns, communication, information and education are also necessary and useful in the fight against smoking.

In addition, the World Health Organization has required the use of warnings to be shown on cigarette packages. These warnings expose the harm caused by tobacco, and can contribute to a change in consumer behavior.

The strong urge to smoke at any time,

- Emergence of anxiety, nervousness, depressed mood in case of lack.

Studies have shown that there is no threshold level below which tobacco is not harmful to health because few cigarettes a day is enough to cause disease:

- One in three cancer is caused by smoking. The most common are the cancer of bronchus and lung, throat cancer, cancer of the larynx. Others are more rare but serious as cancer of the kidneys or bladder.

- Smoking is also part of risk factors cardiovascular responsible for the occurrence of heart attacks and strokes.

- Smoking is responsible for various respiratory diseases such as chronic bronchitis are the most common.

- The affected eye may be complications with smoking onset glaucoma (optic nerve disease causing a progressive loss of visual acuity).

Nicotine addiction

The addiction to tobacco is the fastest installation dependence (a few weeks).

Each cigarette strengthens tobacco addiction.

Installation of addiction mechanism and effects

The mechanism of tobacco addiction is the result of mechanisms of habit and social pressure.

The main factor is the dependence of nicotine in tobacco is a substance that acts on the brain with stimulation of the reward system encouraging smokers to consume more.

The effect of nicotine in the body occurs rapidly (within 8 seconds) and lasts about 20 to 40 minutes.

The effect of nicotine is easily managed by the subject and is essential in achieving the daily activities and obligations: Nicotine is an antidote to anxiety and stress generated by situations of everyday life. It is a source of fun, relaxation and intellectual stimulation for the consumer.

In addition, smoking introduces usual gestures that reinforce confidence and becomes more and more difficult to control.

Testimony on tobacco addiction

Anne 21 years: I smoke and I smoke ... and I do not eat!

I started smoking at age 12 and then I promised my brother to stop. I even signed a contract with him. Now, I stopped for six months and I am very proud of myself. I used patches and took anxiolytic and antidepressant for a month. I faced my mood swings, my anger, my fears and all my emotions I learned to live with.

I became another, and dedicated myself to reading, other activities. I do not work too but I have good results with partial. I listen more to my needs and I know now that I need to learn to respect them. I gained more confidence in myself now and I'm proud. Now I respect and not destroy my body. I want to live because I have a body "new" and "clean."

Only, I did not pay attention to my line. Since I stopped, I took 6 pounds! However, I did not have complex and I found my beautiful body! I am aware that I have spent years to smoke more to eat less, to stay and forty-seven pounds ... And then I realize that I feel more beautiful with my 6 pounds more!!

Stop smoking, it's magic. This is a great adventure where we discover each day a little more. So for all those who are addicted, stop because you have everything to gain!

Prevention and treatment of alcohol

The alcohol addiction can be treated like any disease. However, the first test of cure is abstinence from alcohol at the beginning of treatment.

Prevention of addiction to alcohol is based on information and education programs in order to achieve changes in behavior early.

Prevention

These information and education programs can also be done as:

- Information through the media to strengthening messages and target groups (distribution documentary about addiction to alcohol)

- Information workplace integrated into the health policy of the employer

- Information and education for young people in schools

- Organization of workshops and public forums to flow more easily posts in the community.

To prevent the onset of addiction to alcohol, it is also important to detect alcoholism in an individual at an early stage that is to say in the absence of physical, psychological and biological complications. This is the role of the physician who is responsible for the clinical and biological evaluation of the state of dependence.

Care and treatment

Given the importance of psychosocial factors in the onset of addiction to alcohol, its psychosocial care greatly involves the presence and support of the environment and should include:

- Couples therapy

- Family Therapy

- Group therapy

- Associations of former drinkers

- Cognitive and behavioral therapies

Drugs, however, are used for the treatment of alcohol dependence and statistics have shown that 30 to 50% of patients who received the drug treatments have become abstinent after one year.

However, the administration of these drugs in the treatment of alcoholism requires medical care associated with taking social and psychological care.

Medication

Different classes of drugs can be used in the treatment of alcohol dependence.

Benzodiazepine class

Painkillers

Reducing signs of withdrawal (tremors, sweating, palpitations)

Prevention of delirium tremens

Class disulfirames

Causes a distaste for alcohol causing unpleasant physical sensations when drinking (palpitations, nausea, vomiting, feeling of impending death)

Class of naltrexone

Remove the desire to drink alcohol

Relapse Prevention

Impacts of alcohol

Alcoholism can cause neuropsychiatric disorders manifested by more or less severe clinical signs of brain damage or encephalopathy, intellectual impairment or alcoholic dementia.

Impact on health

The alcohol addiction for several years resulting in chronic health problems such as

- Cardiac disorders (arrhythmias, heart damage)

- The brain damage with the appearance of lesions in the progressive destruction of brain cells

- Diabetes can occur when alcohol poisoning. The most serious risk is the occurrence of a fatal hypoglycemia when drinking on an empty stomach.

- Hypertension

- Involvement of the liver cirrhosis of the liver

- The gastric damage with the appearance of gastric ulcers and gastritis

- Damage to the nervous system manifested by loss of feeling in the limbs and other parts of the body.

social repercussions

The alcohol dependence may induce social complications especially for young subjects:

- Learning difficulties may arise

- Problems of delinquency deviant behavior vis-à-vis society can lead to a family avulsion and / or professional

- Legal issues in relation to delinquent behavior

The social cost of alcohol addiction is becoming increasingly important. The medical cost of alcohol is 10 to 15% of health spending.

In business, 50% of productivity losses are related to alcohol addiction (absenteeism, behavior problems in the workplace with verbal or physical abuse, craving causing accidents on machinery, ...)

Symptoms of Alcoholism

The alcohol dependency is a disease that slowly progressive course and has two clinical forms.

Signs of addiction

In addition to the criteria of Goodman, addiction to alcohol is manifested by other signs of non-control drinking.

We talk about addiction to alcohol when three of the following signs appear in the subject:

- The subject has a tolerance to alcohol with need higher amount to get the desired effect

- The subject addicted to alcohol knows the risks and negative consequences of alcohol (professional consequences, effects on health, effects on the environment)

- The subject wants to stop but can not do

- Alcohol is taken in the morning early in the day

- The subject is hiding bottles of alcohol on the workplace or at home

- The subject likes to drink alone and sometimes in secret

- Alcohol consumption is the most important topic of occupation by sacrificing other leisure activities and obligations.

Alcoholism: two clinical forms

acute alcoholism

Aggressive states

trough

Coma and confusion and can lead to death

chronic alcoholism

tremors morning

Vomiting, diarrhea, sweating, nervousness

Anguish and anxiety

Visual, tactile and auditory hallucinations

Seizures with disorderly movements (delirium tremens)

Alcohol: installation of a dependency

Addiction to alcohol is often a social problem.

Dependence is evaluated according to specific steps.

Stages of alcohol

- Simple use is occasional or regular and moderate consumption.

- The use of risk is likely to lead to addiction.

- Harmful use is a more advanced stage with repeated use.

- Use with addiction is characterized by a loss of control of the use and appearance of signs of withdrawal in case of lack.

Effects of Alcohol

The effects of alcohol are:

- Changes in behavior: removal of the inhibition social as well as personal (the person talks a lot and feels no discomfort)

- A decrease in anxiety and depression by calming power

- A change in the state of consciousness in order to circumvent and escape realities: the person becomes increasingly forgetful to forget all their problems, reacts badly and loses the ability to make decisions.

Installation mechanism and effects of addiction

Alcohol consumption causes the production of Tetra Hydro Papavéroline or THP at the agency that it is present for about 3 months. As a certain amount of THP is still circulating in the blood, calls for alcohol consumption are important.

Once engaged, the body constantly seeks the presence of alcohol.

However, alcohol is facilitated by psychological, social and cognitive factors, maintaining consumption.

Generally, subjects at risk are people with anxiety disorders who have difficulty managing stress, people who have difficulty communicating with others or individuals often with depressive states.

On the social level, these people are at risk because they are often isolated loneliness is imposed, as in some situations: topics unemployed or marital conflict. In alcohol dependence, the surroundings and the environment plays an important role as a factor of dependence.

Personality traits are found with frequency. It is mostly subjects with low self-esteem and who feel ineffective and weak. They then engage in alcohol and its effects expect positive attitudes towards society.

Support for addiction

It is necessary to assess the level of dependence before starting any treatment.

According to several associations and centers of care for addictions, before any treatment, must be able to recognize his addiction problem and talk openly to the doctor, a trusted person or groups of people who can provide assistance.

Psychosocial care

This psychosocial support is important and is often undertaken by health centers (doctors, social workers and specialists). They can be made, as appropriate, in the form of individual interviews or group therapy (family, friends, children, spouse, other patients).

The group therapy are frequently companies because the notion of a group is an important motivating factor facilitating communication between the subject and the other, helping to treatment.

In psychosocial care, treatment is mainly focused on the motivation for abstinence, and awareness of the subject of the consequences of addiction on him and his entourage.

Several associations and specialized care centers currently operating in the field of addiction to support the addiction disorders dependent subjects.

Therapeutic management

Drug treatments are generally used in addition to psychosocial care.

  The medications vary depending on the type of addiction and are prescribed only by a doctor's care center or an addiction psychiatrist.

Addiction prevention

Addictions have adverse health consequences. They affect the proper functioning of the body and then cause disturbances in several processes including brain function.

However, symptoms vary depending on the type of addiction (addiction to tobacco, alcohol addiction, gambling addiction, ....).

Consequences of addiction

All addictions have repercussions on both the health of the social life of the subject.

Generally, addictions often lead to shame, lies, neglect, aggressiveness, isolation, obsession, loss of control, lack of self-esteem, anxiety and suffering.

Several diseases and complications in the body can also occur as a result of dependence, but vary depending on the type of product or creating behavioral addiction.

Addiction prevention

Addiction prevention involves primarily the individual and requires a balanced life:

- On the social level: conflict management, dealing with the emotional problems

- On a professional level: foreclosure professional overwork, time management and labor

- Biologically: follow a healthy diet, follow the rhythm of sleep, practice exercise, crowding stress.

The prevention of addiction also involves socio-political public health intervention.

It should focus on:

- Monitoring the health of the general population

- Monitoring the quality of life of the population census of the sick, dependent persons, persons with disabilities

- Information and health education of the population (of forums, debates, workshops, programs in the media, ...)

- Identification and monitoring of risk factors related to addiction (environmental factors, working conditions, ...)

- Improved system and health care for effective prevention and treatment of addictions (training of health personnel, ease of access to care centers addictions, good management of addiction in schools health and health centers,

- Deepening of knowledge and research on addictions in order to better prevent and provide adequate and appropriate treatment for addicts.

- Application of laws concerning the consumption of psychoactive products assets

Prevention methods vary for each region and each country, depending on the type of population and location. But generally, prevention programs are based on communication for behavior change. Several centers or associations with specialized health personnel currently working in the management of addiction.

Addictions in figures

It is estimated that 90% of people are victims of any addiction.

This can range from a simple to a complete addiction habit with adverse physical and psychological consequences.

In France and in other European countries, addictions today is a public health problem. Addictions are harmful to the addict but also about have consequences for those around him.

Generally, these are men who are more affected than women, most addictions. Dependence is common between ages 15 and 25 because the behavior of adolescents and young adults makes the risk of addiction from the first experiments with substances or activity.

Alcohol and drugs are the most consumed. Currently, 35% of young people under 17 already use alcohol or cannabis, and one teenager in five takes cannabis more than 10 times a year.

In addition, between 1.5 million and 2 million people are addicted to alcohol in France with an average consumption of 19 liters per person per year for over 15 years.

According to the French Ministry of Health, dependence on psychoactive substances causes over 100 000 deaths from accidents and diseases in France and is responsible for 30% of deaths before age 65.

Psychological mechanism of addiction

Biological and social mechanisms alone are not sufficient to create the phenomenon of addiction.

addictions

For example nicotine alone can not lead to a state of dependency in a smoker or the effect of alcohol alone does not give the state of dependence. Mental characteristics of the subject come into play and are heavily involved in the addiction process.

In the psychological mechanism, the subject tries to replace his lack of affection by an object or activity in order to find pleasure and avoid pain. It is then the result of a loss of control of emotions or difficult to manage positive and negative emotions.

People at risk of addiction are often anxious people, depressed, with a lack of confidence, which is easily engaged with an object or act.

Social mechanism of addiction

The social environment of an individual is also a factor of development of addiction. There is a special environment that fosters addiction such as isolation, boredom, lack of understanding, coping strategies.

Coping strategies are behaviors of an individual who can help to cope with difficult situations or constraints as seek to circumvent a problem occupations, modifying its behavior to hide its weaknesses and feelings (bulimia ), easily take psychoactive substances to face its problems (alcohol, drugs, heroin, cannabis, ...).

Several social mechanisms may be involved in the onset of addiction and yet remain fickle factors:

Insecurity and poverty, poor living conditions causing suffering stress. These situations usually lead susceptible individuals to easily hang on psychoactive substances to circumvent the problems caused.

The social exclusion of people addicted to drugs exacerbates the phenomenon of dependency among these people, causing social complications such as delinquency, incarceration ....

Patterns of behavior that are currently imposed by society with trends

hyperconsumption (excessive consumption and purchase of mobile phones, MP3 players, computers, ...) which initially was entertainment then comes the stage where the feeling of physical security leading to a source of pleasure and addiction appears

adapt to various changes in the competitive world (stay good in all areas, to improve steadily against competitive) then use all means in order to overcome the other, increasing the risk of dependency by making drugs to cope with stress and anxiety produced by the situation ....

The family environment can influence the appearance of addiction among many teenagers and young adults. Indeed, it has been shown that most parents have a high level of education (stress at work, lack of control and supervision of children and young adolescents with frequent output buddies with the appearance of group pressure and negative influences ...) more teens are exposed to resort to addictions.

Biological mechanism of addiction

Several mechanisms of addiction have been described in the biological, social and psychological.

Dependence on a product or an act is related to neurobiological mechanism: everything happens in the brain.

Substances produced by the brain as dopamine and serotonin are involved in the management and control of human emotional states and influence the brain-seeking behaviors of fun, impulsive and aggressive activities.

The mere sight of the product or something reminiscent of an act or object (smell, shape, texture) cause an increase in the secretion of dopamine and serotonin stimulate the brain and have an increased urge to the substance or the completion of the act and motivating the individual to use the product or perform the act. This is the circuit of the reward system.

The reward system of the brain essential for survival is a system that participates in the vital functions acts related to nutrition and reproduction, acts related to the satisfaction and pleasure.

Psychoactive substances (alcohol, drugs, ...) are substances that alter the system by modifying its operation led to the dependence of the body to these substances.

Addiction: definition according to DSM-IV

According to the DSM-IV, an addiction is an inadequate method of substance use leading to functional impairment or clinically significant distress.

Addiction is characterized by the presence of at least three events are as follows, over a continuous period of twelve months.

criteria

Tolerance as defined by either of the following symptoms:

        Need for markedly increased amount to get the desired effect.

        Markedly diminished effect with continued use of the same amount of the substance.

Withdrawal characterized by either of the following events:

        Appearance of characteristic withdrawal syndrome for the substance

        The same substance or a loved one is taken to relieve or avoid withdrawal syndromes.

The substance is often taken in larger amounts or over a longer period than intended.

There is a persistent desire or unsuccessful efforts to cut down or control substance use.

Much time and activities went for the substance.

Social, occupational or recreational activities are given due to the use of the substance.

The substance use is continued, although the person is conscious of his physical or psychological problem caused by this substance.

Addiction: definition according to ICD-10

According to ICD-10 (International Classification of Diseases), we speak of addiction when at least three of these criteria have emerged simultaneously in the first year and persisted for at least one month or have occurred again a shorter or longer period.

criteria

A compulsive desire to consume the product.

Difficulties in controlling its use.

Appearance of a withdrawal syndrome when stopping or taking the product to avoid a withdrawal syndrome.

A tendency to increase the dose to achieve a similar effect.

Adverse impact on daily life.

A continued use despite suffering it causes.

Criteria by Aviel Goodman

Of common diagnostic criteria for addiction have also been established in 1990 by Aviel Goodman, American psychiatrist who gave a definition of addiction.

"This is a process which is carried out in a behavior that can have the function of providing pleasure and relieve internal discomfort, and is characterized by the repeated failure of its control and persistence in spite of negative consequences."

The criteria are similar to those of the defining criteria of the DSM-IV and ICD-10.