La responsabilité médicale des accidents de la circoncision en Tunisie : à propos de trois affaires judiciaires

Circumcision is the most frequently performed surgical procedure worldwide, mainly as part of religious rituals. It may lead to serious complications. Although there is no specific law relative to circumcision accidents in Tunisia, the occurrence of complications of this act is likely to engage the penal, civil and disciplinary liability of the doctor. Prevention involves respecting the principles of the Medical Deontology Code, raising awareness about the need to practice circumcision in a medical environment and the promulgation of specific legislation regulating this act. The new Tunisian law on medical liability seems to offer a solution to solve the legal complaints concerning circumcision accidents by providing more opportunities for amicable settlement and at the same time guaranteeing adequate and rapid compensation of the prejudice. In this article, we discuss the medical liability of circumcision accidents through three medicolegal cases carried out at the Department of Legal Medicine of Ibn El Jazzar University Hospital, Kairouan, Tunisia.     

La perception de la responsabilité sociale des Entreprises : adaptation et validation française de l’échelle de Maignan et Ferrell, 1999

This study proposes to apply the paradigm of Churchill in the case of the adaptation in french and validation of the Maignan and Ferrell scale (1999) based on the model developed by Carroll (1979). This model proposes to distinguish four principles of social responsibility: economic, legal, ethical and philanthropic responsibility. Four factors were highlighted in a first exploratory study conducted among 320 workers. This structure was confirmed during a second confirmatory investigation among 287others workers. If the four identified factors do not match exactly to the theoretical chosen model, they bring value to support the differences in social responsibility between the internal actors and external actors.     

L’évaluation de la perte de chance en responsabilité médicale,une mission à repréciser pour l’Expert

Loss of opportunity, which today is considered as a prejudice in its own right, both for the French Supreme Court and the Council of State, remains undeniably difficult to assess in practice. For many years, the issue of compensation for breach of duty of disclosure gave the various courts the ability to roadtest this concept. However, although the criteria defining this concept, of judicial origin, have been established, the modus operandi allowing the judge to quantify it does not exist. How can this portion of personal injury be determined in relation to the size of the opportunity lost? This is primarily a technical issue, similar to that of assessing a disability rate. However, this request does not feature in typical common law missions for judicial or administrative medical expertise. The judge alone is left to assess this probability, whereas the expert would be in a position, as far as possible, to provide scientific and statistical assistance enabling a better definition of loss of opportunity.     

La consistance de l’intervention éducative parentale : la qualité de l’environnement familial et les comportements interactifs de la mère

Parental child rearing can be analysed through the observation of child-rearing behaviours and also through the way parents organize home environment. This study intends to identify the home environmental quality dimensions that are related to maternal interactive behaviours after accounting for maternal education level.The participants were 120 mothers of children aged 14 to 49 months. The quality of home environment was assessed with HOME Inventory for Families of Infants and Toddlers (Caldwell and Bradley, 1984). Interactive behaviours were collected, video registered and coded using the Mothers Teaching Styles Rating Scale (Cruz, Aguiar and Barros, 2004; McWilliam et al., 1996).Positive associations were found between HOME total score and the responsiveness and active teaching dimensions of maternal interactive behaviour; these associations decreased after accounting for maternal education level. Negative associations were found between home environment and non contingent involvement; but these associations slightly increased after accounting for maternal education level.     

Sentiment de responsabilité pour le changement et l'innovation dans le contexte du comportement de santé : le rôle de la charge de travail cognitive,le leadership,l’autonomisation et la personnalité proactive

The innovation is one of the possible answers to the actual global competitive context able to foster and cope the high standards necessary for survival and competition of the organisations. The objective of this study, realized in the health context, is the exploration of the relationships between the innovative work behaviour and three antecedents (proactive personality, job cognitive demands and empowering leadership) trying to maintain the interactionist perspective between individual factors and context factors. These relationships have been investigated with a mediator role of felt responsibility to change, the individual belief that has a person when has feeling of responsibility in a realisation of transformations and new and constructive changes.     

Les techniques biomédicales en matière d’assistance médicale à la procréation conçues dans l’objectif de pallier l’infertilité médicale peuvent-elles évoluer de manière à être utilisées pour remédier à l’infertilité sociale ?

Medically assisted procreation includes techniques that may allow infertile couples to procreate. However, the application of 2011 bioethics law reveals lots of paradox and high-risk behaviors which arouse the question of the relevance and advisable aspect of its opening to all women.     

La portée normative des avis d’expert dans l’élaboration de la décision administrative en matière de sécurité sanitaire

The development of scientific knowledge and the complexity of the issues of health safety have led to increase the use of expertise. The need for transparency following the “scandals” at the end of the last century has led the state to outsource its assessment procedures in health safety, by creating independent agencies. These agencies turn to outside experts because their own staff does not have all the necessary competence. So, the question is: what is the role of these experts in the elaboration of the standards made by the decisions of the agencies? The link between the decision and the expert advice may be almost considered as subordination: the administrative decision becomes stuck by the advice, due to the technical incompetence of the agency. But the circumstances of the administrative decision, especially the situation of scientific uncertainty, can impose a degree of autonomy. If the scope of expert advice seems considerable in certain aspects, it should not hide the full responsibility of policy makers.     

La faute médicale caractérisée en droit pénal français est-elle liée à des qualifications d’intensité et de gravité ?

Medical misconduct in criminal law could be qualified as characterized by judge. It would be determined by the fact that the medical practitioner exposes a patient to health danger with full consciousness. This medical misconduct could be done during positive act or guilty abstention. But the legislator didn’t clarify the term “characterized” of fault in the bill. Precise definitions were established by dispute at law. In the medical field, an analysis was performed when indirect causality was involved by supreme judge. The majority of court rulings were based on criminal negligence which couldn’t be ignored by the medical doctor that endangers health patient. Intensity and gravity in criminal negligence were systematically demonstrated. That could be considered as the term “characterized” in the medical fault.     

Validation francophone de l’échelle de sécurité des perceptions d’attachement au père et à la mère (Kerns,Klepac & Cole, 1996)

IntroductionAlthough most researchers recognize the importance of parent-child relationships in child development and well-being, currently few methods designed to assess attachment quality after age 6 and before adolescence are validated in French.ObjectiveThe objective of this study was to validate the French adaptation of the security scale (mother and father forms).MethodExploratory and confirmatory factor analyses were conducted on the data collected with 210 children aged between 8 and 12 years old. Internal consistency, test-retest fidelity, and convergent validity of the scale were tested using Cronbach alphas and correlation analyses.ResultsAlthough 5 of the 15 items were deleted, results confirmed the unidimensional structure of the scale, and revealed its good psychometric properties.DiscussionThis instrument should be very useful for both researchers and practitioners who want to have a first insight on the quality of children's attachment relationships during middle childhood.     

Les dispositifs groupaux à l’hôpital et en EHPAD durant la crise de la Covid-19. Quelles demandes,quelles offres,quels apports ?

IntroductionThe COVID-19 crisis has exacerbated the demand for group arrangements dedicated to healthcare professionals and more widely hospital and medicosocial staff.ObjectiveThis article attempts to shed light on the issues at stake in the opening of group settings, between supply and demand, as well as their main organizational and psychological contributions and limitations, through the synthesis of multiple feedbacks from group arrangements carried out by clinical psychologists and researchers during the COVID-19 pandemic.MethodSix female researcher-clinicians met to discuss their experiences in setting up group care facilities. The analysis of the feedback used the concepts of work psychodynamics and group psychoanalysis, making it possible to bring out the organizational and psychological characteristics of group arrangements dedicated to professionals in the healthcare sector.ResultsOur results show that the group arrangement, by allowing the sharing of experiences, helps the mutual recognition between professionals, and thus new identifications in order to avoid the fragmentation of work collectives. The most central point seems to be the capacity of group arrangements to deal with the aggressiveness and anger felt when facing the powerlessness to act in crisis situations. The limits of these groups concern their difficulty in allowing individual rather than collective words to be expressed, and the risk of being the site of a repetition of the trauma for the professionals who sometimes attack or flee from these mechanisms, for fear of what they might bring back to the surface.ConclusionSeveral points of vigilance and recommendations from the experiences reported in this article are explained, in order to enlighten and guide future group facilitators when offering group arrangements built with and for professionals in the healthcare field.     

Faire face à des émotions négatives intenses en protection de l’enfance : un travail émotionnel qui mobilise des processus de régulation de l’anxiété et de la colère avec le soutien de l’équipe

This research aims at a better understanding of one aspect of emotional labor in child welfare: coping with intense negative emotions. It is based on 15 interviews conducted with social workers from Child Protective Services. Results indicate that the drivers of this aspect of emotional labor are characterized by unpredictability and interpersonal conflict. They give rise to surprise, anxiety and especially anger, particularly against institutions. Emotional regulation is carried out implicitly with a professional instrumental purpose. Different strategies are mobilized sequentially: social sharing of emotions and cognitive strategies allow recovery. The team social support during informal times appears central. These results underline the role of the team and plead for the recognition and professionalization of emotional work in this sector.