L’expertise médicale fondée sur les faits

The concept of evidence-based medicine applies to medical activity in general in order to rationalize it. The medical expertise, constantly looking to improve its quality, can no longer ignore this concept. This is the best tool to meet the mission entrusted to experts of assessing the conformity of care to the scientific-acquired features, without neglecting the assessment of the involved practitioner's skills and the particular circumstances of the plaintiff. This article develops the new concept of “Medical expertise based on facts”.     

Inhomogénéité des évaluations de durée d’incapacité totale de travail. Comparaison d’évaluations des durées d’incapacité totale de travail entre les médecins légistes,les médecins généralistes et les urgentistes

Setting a total length for time off work is a forensic act that all physicians must be able to perform. Given the importance of the legal consequences of this evaluation, it seems desirable that this practice is mastered by all practitioners. However, in practice there is often a disparity between forensic assessments and evaluations provided by other practitioners. To assess this difference in evaluation, we conducted a retrospective study, looking at 4 years of archives, of victims of Marseille's forensic service (CHU Timone), and highlighted a disparity between medical examiners, GPs and emergency physician's assessments. In both comparisons between medical examiners versus GPs (n = 367) or medical examiners versus emergency physicians (n = 511), were found in one third of cases of forensic requalification. The majority of checks on where GP's (80%) determined on over 8 days leave were reassessed under this limit by a medical examiner. This trend is reversed for the majority of (61%) requalification cases of emergency assessments (assessment over eight days by medical examiners. This study, proving a fact long suspected, raises many questions about these disparities evaluation we have discussed.     

Sensibiliser les filles à l'orientation vers les métiers scientifiques et techniques. Évaluation d'un dispositif

Girls’s diversification of career choices seem relatively resistant to training program. One explanation of this situation is the lack or even absence of procedures for evaluating this program. The article proposes an evaluation of a training program entitled “female engineer” designed exclusively for high school girls. The objective was to encourage female students guidance in this profession. The results are mixed and are interpreted in terms of cognitive dissonance and upward social comparison. The results also show the need to develop in the same time the training program and his evaluation.     

Effet du niveau d’études sur les performances en mémoire épisodique chez des adultes âgés : rôle médiateur de la métamémoire

Educational level is a factor of cognitive reserve and older adults with a higher level of formal education have a better memory performance than those having a lower educational level (Angel et al., 2010; Van Der Elst, Van Boxtel, Van Breukelen, & Jolles, 2005). Memory functioning can also be modulated by the beliefs and knowledge of a person about his/her own memory, that is, by his/her metamemory (Hultsch, Hertzog, & Dixon, 1987). The objective of this study was to examine the role of metamemory as a potential mediator of the effect of educational level on memory performance. Eighty-three older adults (60–80 years) participated in the experiment, they have been divided into two subgroups according to their educational level (high: 14.36 years and low level: 9.85 years). Episodic memory was evaluated with a cued recall task and metamemory by the Metamemory in Adulthood questionnaire (MIA). As shown by previous studies, results indicated that educational level had a significant effect on memory and metamemory, higher educational level was associated to better memory and metamemory capacities. At the MIA questionnaire, older adults with a high educational level affirmed using more internal and external strategies for learning, having higher motivation and perceiving less memory change with aging than older adults with a lower educational level. They also showed that the metamemory dimensions associated to the memory performance differed according to the educational level. For participants with a lower educational level, memory performance was correlated to the participants’ perception about their memory capacity and their knowledge about memory tasks, while for participants with a higher educational level, memory performance was correlated to the dimensions linked to memory control (strategies and motivation). Finally, the group effect was mediated by metamemory, specifically by the use of internal strategies. These results suggest that a prolonged educative experience would be associated to a better capacity to implement adapted strategies, which led individuals to maintain an optimal memory performance.     

Le contentieux de la régularité externe des décisions rendues par les juridictions ordinales des médecins

In the event of irregular composition of the ordinal jurisdiction or omission of certain compulsory particulars in the decision rendered, the parties may challenge the external regularity of the decision. The pleas based on the contested decisions are formal and procedural defects. If successful, these means result in the annulment of the decision ordering the doctor to be disciplined. These means constitute a separated legal cause and can only be invoked within the time limit for appeal, unless they are of public order.     

Quels enjeux pour les soins bucco-dentaires sous anesthésie générale chez les adultes ?

Common dental acts sometimes require to be performed under general anesthesia. This article describes the development of an adult consultation for dental care under general anesthesia at hospital Henri-Mondor in Créteil group. Forty-two people received dental care under general anesthesia during the year 2015 at Henri-Mondor hospital. Thirty-eight percent were aged 21 to 30 years. The main reason for using general anesthesia phobias 56%. The second reason, with 31%, is on disability. Among the type of intervention, 61% represent extractions of permanent teeth. However, our study shows that the indication of general anesthesia must be asked as a last resort. Other alternative techniques exist and must be offered an upstream. General anesthesia tends to grow and be part of a comprehensive treatment of certain categories of patients. General anesthesia comfort remains prohibited.     

L’attachement chez les enfants institutionnalisés : une recension narrative et méta-analytique des études sur les facteurs de risque

IntroductionInstitutional conditions are deleterious for child development (Browne, 2009). In particular, at a socioemotional level, a high proportion of institutionalized children develop an insecure-disorganized attachment (van IJzendoorn & Bakermans-Kranenburg, 2009). However, little is known about the risk factors associated with the development of disorganized attachment behavior among children living in institutions.ObjectiveA narrative and meta-analytic review is conducted to identify such risk factors.MethodAll studies reporting valid attachment scores of institutionalized children during infancy (between the ages of 1 and 5) were selected. A total of 16 published studies, out of 9 different research projects, conducted in various countries were found.ResultsOverall results show that structural factors are associated to higher levels of disorganized attachment. The accumulation of risk factors or their interaction are suggested as potential processes explaining insecure attachments in institutional settings.ConclusionResearch questions are suggested for future work.     

Recommandations internationales sur les tests informatisés ou les tests distribués par Internet

In recent years, substantial and rapid developments have occurred in the provision of freestanding and computer or Internet-based testing. These developments raise a number of issues in relation to best practices of administration, security of the tests and test results as well as control over the testing process. To answer these issues, the International Test Commission Council developed guidelines specifically aimed at computer/Internet-based testing, which are internationally approved. This article presents the French adaptation of these international guidelines by the French Psychological Society.     

La relation entre l’usage professionnel des technologies numériques et l’addiction au travail médiatisée par les demandes psychologiques au travail : quelles différences entre les hommes et les femmes ?

Considered as an additional job demand, the use of technologies for work-related reasons could increase psychological demands at work, favoring the appearance of workaholism. Our study examines the impact of the frequency of this use on psychological demands at work and workaholism in a sample of 223 people at work from various professional backgrounds, by verifying whether there are differences between men and women. The results showed that the use of technologies (desktop computer, laptop, tablet, smartphone/mobile phone) for work-related reasons increases psychological demands felt at work, consequently favoring the appearance of the two components of workaholism (working excessively and working compulsively) in men and women. In addition, the results show us gender differences: the strength of the relationship between the use of technologies for work-related reasons and working excessively, partially mediated by psychological demands at work, was slightly higher among men than in women; strength of the relationship between the use of technologies for work-related reasons and working compulsively, partially mediated by psychological demands at work, was found just among men, whereas a full mediation was found among women. This research highlights the importance of investigating the mechanisms that may explain how the use of technologies for work-related reasons could enhance the risk of work addiction, by considering gender differences.     

Comment les enfants utilisent-ils les catégories de sexe ?

Are children aware of the social asymmetry that governs relations between individuals of both genders? Is the cognitive asymmetry described for adults by Hurtig and Pichevin (1998) visible to children? This research shows how 446 5- to 11-year-old children use gender categorization to describe a fictious person to a partner, using the paradigm developed by Hurtig and Pichevin (1990). Some results are consistent with those shown by adults, however others are not and seem to indicate a greater sensitivity amongst the youngest in the mixed situations (subject and partner are of opposite sex), and thus, this is also different according to the gender of the two protagonists. These different results can be explained by the social behaviour of girls and boys at school.     

La force normative du contrôle ordinal des contrats conclus par les médecins

Professional contracts concluded by physicians are specific. Indeed, these contracts must be compliant with ethical standards of the profession. As a professional authority, the College of physicians introduces obligations under which professionals have to stipulate several specific clauses and transmit their written contracts to the College, which controls their conformity. However, the normative power of these obligations is weak. To ensure the respect of ethical standards in professional contracts, soft law is more and more used by the College.     

L’intention comportementale dans les pratiques ménagères : faire soi-même son produit ménager pour moins polluer

Partly due to everyday products discharge, the presence of micropollutants in the sewage system highly concerns the public authorities and water stakeholders. Our study is focused on the measurement of the intention to substitute usual household products by a “homemade” product more eco-friendly. 304 questionnaires were completed by the inhabitants of the Strasbourg Eurometropole and were analyzed by using the theory of planned behavior (TPB). The results show that TPB explains 35 % of intention to use the “homemade” product. It seems that the respondents have a positive attitude toward this “homemade” product. It also appears that there is a strong capacity constraint of this product in terms of disinfection although this parameter is essential when choosing a household product.     

Stimulation cognitive chez les personnes âgées : effets d’une méthode de stimulation cognitive par les jeux sur les fonctions cognitives et l’estime de soi

The purpose of this study was to examine the effects of a cognitive stimulation program with games on scores to cognitive tests (processing speed, mental flexibility, working memory, inhibition) and how this program can benefit to a psycho-affective measure, self-esteem in older adults. Forty-eight participants over 60 years old took part in the experiment. They were divided into two groups: 1 group followed a program of cognitive stimulation using leisure activities with games and 1 control group in which people gathered every week. There were 8 sessions of cognitive stimulation using leisure activities like games, one-hour session a week. Measures have focused on speed of processing and executive functions (shifting, updating and inhibition). They have been evaluated before and after the training program. Results show that the cognitive stimulation program using leisure activities with games is effective on speed of processing, memory span, inhibition and self-esteem but shows no benefits on shifting and updating. These results indicate that it seems to be possible to enhance cognitive resources, inhibition and self-esteem using leisure activities with games as a tool for cognitive stimulation.     

Dynamique identitaire et déclassement : les jeunes diplômés d’un Bac+5

The aim of this research was to study the impact of the over education suffered by a young woman holding a Master degree on her identity dynamics. We conducted an exploratory research using the IMIS (Zavalloni, 2007). Also based on the model of the dynamical system capability (Costalat-Founeau, 2008, 2013), this study demonstrated a dynamic identity marked by the difficulties in the professional integration process. Discourse analysis also revealed a feeling of capabilities acting as a defense to a normative capacity lacking a social non-validation but also as compensation for a lack of professional recognition.