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Accompagnement des jeunes trans ou en questionnement de genre, mise au point sur les recommandations internationales 为跨性别青年提供咨询或性别问题,根据国际建议制定
Q4 Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jpp.2024.07.005
L. Berthonneche , M. Lapoirie , L. Jurek
Les demandes d’accompagnement de mineurs en questionnement de genre ont augmenté ces vingt dernières années. Plusieurs sociétés savantes ont proposé des lignes de conduite pour l’accompagnement de ces jeunes dans l’exploration de leur identité de genre, l’évaluation de leurs besoins et de leurs demandes, et l’accompagnement vers des soins adaptés et individualisés. Après un bref rappel de terminologie et d’épidémiologie, cet article synthétise les standards de soin internationaux proposés pour ces jeunes, sur le plan de l’accompagnement général, psychiatrique, et endocrinologique.
Requests for support for minors questioning their gender have increased over the past twenty years. Several scholarly societies have proposed guidelines for supporting these young individuals in exploring their gender identity, assessing their needs and requests, and guiding them towards tailored and individualized care. After a brief overview of terminology and epidemiology, this article synthesizes the international standards of care proposed for these youths, covering general, psychiatric, and endocrinological support.
在过去的20年里,对未成年人的性别指导的要求有所增加。一些学术团体提出了指导这些年轻人探索其性别认同、评估他们的需求和要求以及指导他们获得适当和个性化的护理的指导方针。在简要回顾术语和流行病学之后,本文总结了为这些年轻人提出的国际护理标准,包括一般护理、精神病学和内分泌学。在过去的20年里,对质疑自己性别的未成年人的支持请求有所增加。一些学术协会提出了指导方针,以支持这些年轻人探索其性别认同,评估他们的需求和要求,并指导他们获得有针对性和个性化的护理。在简要概述了术语和流行病学之后,本文综合了为这些年轻人提出的护理的国际标准,包括一般、精神病学和内分泌支持。
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引用次数: 0
Actualités pharmaceutiques 医药新闻
Q4 Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jpp.2024.10.005
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引用次数: 0
Troubles respiratoires obstructifs du sommeil chez l’enfant 儿童阻塞性睡眠呼吸障碍
Q4 Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jpp.2024.07.004
L. Coutier , G. Aubertin , C. Schweitzer , I. Ioan , P. Franco
Chez l’enfant, le syndrome d’apnées obstructives du sommeil (SAOS) constitue un trouble fréquent entre 3 et 8 ans (∼3 %). Les symptômes et les signes cliniques diurnes et nocturnes à rechercher sont le résultat de l’obstruction des voies aériennes supérieures et de la mauvaise qualité de sommeil. Ils permettent de juger de la probabilité du diagnostic de SAOS et d’évaluer sa sévérité. Après une évaluation anamnestique et clinique complète, le spécialiste ORL s’orientera soit vers une adéno-amygdalectomie (AA), soit vers un suivi rapproché, soit vers un enregistrement nocturne par polygraphie ou polysomnographie pour confirmer le diagnostic. La prise en charge de ces enfants est multidisciplinaire (ORL, orthodontiste, kinésithérapie maxillo-faciale, pneumologue, spécialiste du sommeil) et doit être précoce afin d’éviter les complications neurocognitives, comportementales, cardiovasculaires, et métaboliques. Une évaluation des règles d’hygiène de vie et de sommeil ainsi que du surpoids ou de l’obésité est indispensable. Chez l’enfant avec SAOS de type 1 ou l’enfant avec SAOS de type 3, des spécificités sont à retenir et sont détaillées ici.
In children, obstructive sleep apnea syndrome (OSAS) is a common disorder between 3 and 8 years of age (∼3 %). Daytime and nighttime clinical symptoms and signs of OSAS are the result of upper airway obstruction and poor sleep quality. Clinical symptoms and signs lead to evaluate the probability of OSAS diagnosis and its severity. After a complete anamnestic and clinical evaluation, the ENT specialist will propose an adenotonsillectomy (AA), or follow-up, or sleep evaluation by polygraphy or polysomnography to confirm the diagnosis. The management of these children is multidisciplinary (ENT, orthodontist, maxillofacial physiotherapist, pulmonologist, sleep specialist] and must be early in order to avoid neurocognitive, behavioral, cardiovascular and metabolic complications. An assessment of lifestyle and sleep hygiene rules as well as overweight or obesity is essential. In children with OSAS type 1 or children with OSAS type 3, specific characteristics should be remembered and are detailed here in.
阻塞性睡眠呼吸暂停综合征(OAS)是3 - 8岁儿童的常见疾病(~ 3%)。需要注意的白天和夜间的症状和体征是上呼吸道阻塞和睡眠质量差的结果。它们有助于判断诊断OAS的可能性和评估其严重程度。在进行完整的失忆症和临床评估后,耳鼻喉科专家将转到腺扁桃体切除术(AA)或密切随访,或使用测谎仪或多睡眠图进行夜间记录,以确认诊断。这些儿童的护理是多学科的(耳鼻喉科医生、正畸医生、颌面理疗师、肺科医生、睡眠专家),必须及早进行,以避免神经认知、行为、心血管和代谢并发症。对健康的生活和睡眠规则以及超重或肥胖进行评估是必不可少的。对于患有1型SAOS或3型SAOS的儿童,需要记住一些特征,并在这里进行详细说明。在儿童中,阻塞性睡眠呼吸暂停综合征(OAS)是3 - 8岁之间的常见疾病(~ 3%)。OSAS白天和夜间的临床症状和体征是上呼吸道阻塞和睡眠质量差的结果。临床症状和体征有助于评估OSAS诊断的可能性及其严重程度。在完整的病史和临床评估后,ENT专家将建议进行腺切除术(AA),或随访,或通过测谎仪或多眠仪进行睡眠评估,以确认诊断。这些儿童的管理是多学科的(耳鼻喉科医生、正畸医生、颌面理疗师、肺科医生、睡眠专家),必须尽早进行,以避免神经认知、行为、心血管和代谢并发症。对生活方式和睡眠卫生规则以及超重或肥胖的评估是必不可少的。在OSAS 1型或OSAS 3型儿童中,应记住具体特征,并在这里详细说明。
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引用次数: 0
Annonce d’une mauvaise nouvelle concernant un enfant 关于孩子的坏消息
Q4 Medicine Pub Date : 2025-01-31 DOI: 10.1016/j.jpp.2025.01.001
A. Challan Belval , E. Semon
Cet article est à la fois le partage d’une expérience professionnelle et une notice permettant d’identifier certains comportements fréquents lors de l’annonce d’une mauvaise nouvelle. Pour cela, les auteurs ont choisi de prendre le temps de décrire les mécanismes de défense tant du côté des patients que ceux des soignants. En effet, le patient qui reçoit l’annonce met en place des stratégies pour se protéger de ce qu’il est en train d’apprendre et le médecin de son côté doit s’adapter à la réaction, parfois violente ou déstabilisante, du patient. Il est essentiel de connaître les mécanismes de défense afin de pouvoir les repérer et les accueillir et ainsi d’ajuster son discours pour permettre au patient de se sentir entendu dans sa souffrance.
This article is both the sharing of professional experience and a guide to identifying certain behaviors that are common when breaking bad news. To this end, the authors have taken the time to describe the defense mechanisms of both patients and caregivers. Indeed, the patient who receives the news implements strategies to protect himself from what he is about to learn, and the doctor for his part must adapt to the patient's reaction, which can sometimes be violent or destabilizing. It is essential to be aware of the patient's defense mechanisms, in order to be able to identify and deal with them, as well as adjusting one's approach to enable the patient to feel heard in his or her suffering.
这篇文章既是专业经验的分享,也是在宣布坏消息时识别一些常见行为的指南。为了做到这一点,作者选择花时间描述患者和护理人员的防御机制。事实上,被告知的病人会制定策略来保护自己不受他或她正在学习的东西的影响,而医生则必须适应病人的反应,有时是暴力的或不稳定的。了解防御机制是至关重要的,这样我们才能识别和接受它们,从而调整我们的语言,让病人在痛苦中感到被倾听。这篇文章既分享了专业经验,也提供了一个指南,以识别在突发坏消息时常见的某些行为。为此,作者花时间描述了患者和护理人员的防御机制。事实上,接受新闻的患者实施策略来保护自己不受即将学习的内容的影响,而医生则必须适应患者的反应,这种反应有时可能是暴力或破坏稳定的。重要的是要意识到病人的防御机制,以便能够识别和处理他们,以及调整一个人的方法,使病人在他或她的痛苦中感到被听到。
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引用次数: 0
Les RSEV en Île-de-France : expérience du RPSOF-ASNR 法兰西岛的企业社会责任:RPSOF-ASNR的经验
Q4 Medicine Pub Date : 2025-01-31 DOI: 10.1016/j.jpp.2025.01.002
A. Dodille, L. Leloup
Depuis 2015, le suivi des enfants dits « vulnérables » est organisé et harmonisé au sein du programme SEV-IDF piloté et financé par l’ARS IDF et porté par six dispositifs spécifiques régionaux en périnatalité, qui couvrent l’ensemble du territoire francilien. Ce programme propose aux nouveau-nés, prématurés de moins de 33 SA, ou ayant présenté retard de croissance intra-utérin sévère, ou une encéphalopathie anox-ischémique modéré à sévère ou toute autre pathologie susceptible d’altérer leur développement, un suivi, un accompagnement et une prise en charge adaptée à leurs besoins spécifiques jusqu’à 7 ans inclus. Les DSRP assurent le recrutement, la formation continue et la coordination des différents professionnels médicaux et paramédicaux qui interviennent dans le programme. Des difficultés demeurent quant à maintenir l’ensemble des enfants dans le suivi, favorisant ainsi la perte de vue dans le programme SEV-IDF. Ces difficultés sont liées notamment au manque de professionnels dans certains territoires et à la difficulté de maintenir un suivi de longue durée avec certaines familles. Malgré cela, l’inclusion dans le programme SEV-IDF apporte le bénéfice d’un suivi spécialisé et coordonné et donc d’un dépistage précoce de troubles éventuels et ainsi une optimisation du développement d’un grand nombre d’enfants vulnérables.
Since 2015, the follow-up of so-called “vulnerable” children has been organized and harmonized within the SEV-IDF program piloted and financed by ARS IDF and carried out by six Dispositifs Spécifiques Régionaux en Périnatalité, which cover the entire Île-de-France region. This program offers newborns who are preterm birth under 33 weeks of age, or who have presented severe intra-uterine growth retardation, or moderate to severe anoxic-ischemic encephalopathy or any other pathology likely to impair their development, follow-up, support and care adapted to their specific needs up to and including the age of 7. DSRP ensure the recruitment, continuous training and coordination of the various medical and paramedical professionals involved in the program. Difficulties remain in keeping all the children in the follow-up, resulting in a loss of follow-up in the SEV-IDF program. These difficulties are linked in particular to the lack of professionals in certain territories and the difficulty of maintaining long-term follow-up with certain families. In spite of this, inclusion in the SEV-IDF program brings the benefit of specialized, coordinated follow-up and therefore early detection of possible disorders, thus optimization of the development of a large number of vulnerable children.
自2015年以来,所谓的“弱势”儿童的监测在SEV-IDF项目中得到了组织和协调,该项目由ARS IDF领导和资助,并由覆盖整个法国领土的6个具体的围产期区域计划提供支持。这个方案提供了以下的新生儿、早产儿33次,提出严厉的宫内发育不良,或有中度至严重的anox-ischémique脑病或其他病症,以免影响其发展的一个监测、辅导和治疗适合他们的具体需要,直至7岁。减贫战略文件负责征聘、继续培训和协调参与该方案的各种医疗和辅助医疗专业人员。在监测所有儿童方面仍然存在挑战,从而导致在SEV-IDF方案中失明。这些困难除其他外,与某些地区缺乏专业人员和难以维持对某些家庭的长期监测有关。尽管如此,将其纳入SEV-IDF方案将带来专家和协调监测的好处,从而及早发现可能的疾病,从而优化大量易受伤害儿童的发展。自2015年以来,在ARS IDF试点和资助的SEV-IDF项目中组织和协调了所谓的“弱势”儿童的后续行动,该项目由覆盖整个Ile -de-France地区的6个Disponifs Specifiques Regionaux en Perinatalite实施。This program常newborns who are preterm诞生under 33 weeks of age,可是很严重的臀部intra-uterine增长智力、黄金中度或严重anoxic-ischemic度暂时any other pathology日文to奇数their支撑发展,后续,and care adapted to their具体需要up and the age of包括7摄氏度。该方案的目的是确保征聘、持续培训和协调参与该方案的各种医疗和辅助医疗专业人员。在SEV-IDF项目中,让所有儿童都参与随访的困难仍然存在,导致失去了随访。这些困难尤其与某些领域缺乏专业人员以及难以与某些家庭保持长期后续行动有关。尽管如此,将其纳入SEV-IDF方案带来了专门的、协调的监测和因此而早期发现可能的疾病的好处,从而优化了大量易受伤害儿童的发展。
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引用次数: 0
Sommaire 摘要
Q4 Medicine Pub Date : 2024-12-01 DOI: 10.1016/S0987-7983(24)00149-X
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引用次数: 0
Que devraient savoir les cliniciens au sujet de la microbiologie des pneumocoques ? 关于肺炎球菌微生物学,临床医生应该知道什么?
Q4 Medicine Pub Date : 2024-12-01 DOI: 10.1016/S0987-7983(24)00151-8
R. Cohen , E. Varon
Pneumococci, encapsulated Gram-positive cocci whose polysaccharidic capsule is a key factor in their virulence, are aerotolerant anaerobic micro-organisms that require specific growth conditions. S. pneumoniae is a transformable species with a highly plastic genome. In the nasopharynx, in contact with other streptococci such as S. mitis or S. oralis, it is the key to numerous interspecifictransfers of genetic material, contributing to capsule diversification and protein modifications, including penicillin-binding proteins (PLPs). Molecular identification methods, which are more sensitive than conventional diagnostic methods, aim to detect one or more pneumococcal-specific genes (pneumolysin, autolysin, part of the capsule, etc.). The specificity of these molecular investigation methods increases with the number of genes targeted. © 2024 The Author(s). Published by Elsevier Masson SAS.
肺炎球菌是包封的革兰氏阳性球菌,其多糖胶囊是其毒力的关键因素,是需要特定生长条件的耐氧厌氧微生物。肺炎链球菌是一种可转化的物种,具有高度可塑性的基因组。在鼻咽部,与其他链球菌(如密氏链球菌或口腔链球菌)接触时,它是遗传物质在多种种间转移的关键,有助于胶囊多样化和蛋白质修饰,包括青霉素结合蛋白(PLPs)。分子鉴定方法的目的是检测一种或多种肺炎球菌特异性基因(溶气素、自溶素、部分荚膜等),比常规诊断方法更敏感。这些分子调查方法的特异性随着目标基因数量的增加而增加。©2024作者。Elsevier Masson SAS出版。
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引用次数: 0
Page de titre 标题页
Q4 Medicine Pub Date : 2024-12-01 DOI: 10.1016/S0987-7983(24)00147-6
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引用次数: 0
Spectre des infections pneumococciques chez l'enfant 儿童肺炎球菌感染的光谱
Q4 Medicine Pub Date : 2024-12-01 DOI: 10.1016/S0987-7983(24)00152-X
R. Cohen , N. Ouldali , H. Haas
Pneumococcal infections cover a wide range of diseases, depending on the site of infection and severity. They are classified into two categories: invasive (such as meningitis or bacteremia) and non-invasive infections (such as otitis media). In other hand, pneumococci are normal hosts of the nasopharyngeal microbiota of young children (6 months to 6 years), and over a full year almost 100% of children are carriers, with carriage favored by respiratory infections and life in the community. This article describes four of the most common pneumococcal diseases: acute otitis media, pneumonia, occult bacteremia and meningitis. © 2024 The Author(s). Published by Elsevier Masson SAS.
肺炎球菌感染包括多种疾病,视感染部位和严重程度而定。它们分为两类:侵入性感染(如脑膜炎或菌血症)和非侵入性感染(如中耳炎)。另一方面,肺炎球菌是幼儿(6个月至6岁)鼻咽菌群的正常宿主,全年几乎100%的儿童为带菌者,带菌者受呼吸道感染和社区生活的青睐。本文描述了四种最常见的肺炎球菌疾病:急性中耳炎、肺炎、隐性菌血症和脑膜炎。©2024作者。Elsevier Masson SAS出版。
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引用次数: 0
Impact de l'implémentation des vaccins conjugués à 7- puis 13-valent sur les pathologies à pneumocoque 采用7价和13价结合疫苗对肺炎球菌疾病的影响
Q4 Medicine Pub Date : 2024-12-01 DOI: 10.1016/S0987-7983(24)00156-7
R. Cohen , N. Ouldali , A. Rybak
The introduction of pneumococcal conjugate vaccines (PCV) in the early 2000s had a major impact on public health, both in terms of the incidence of infections and antibiotic prescriptions. Rapidly adopted in the USA with remarkable effectiveness, 7-valent PCV was then introduced in Europe and the UK. In France, implementation has been more gradual, and the impact of this vaccination has been less obvious due to rapid serotype replacement, despite the efficacy of the vaccine serotypes. Here, we present efficacy results for France, based on time-series studies of pneumococcal meningitis, invasive pneumococcal infections, pneumonia and pleuropneumonia, acute otitis media and invasive infections in adults.
© 2024 The Author(s). Published by Elsevier Masson SAS.
21世纪初,肺炎球菌结合疫苗(PCV)的引入对公共卫生产生了重大影响,无论是在感染发生率方面还是在抗生素处方方面。7价PCV在美国迅速采用,效果显著,随后在欧洲和英国引入。在法国,实施更为渐进,尽管疫苗血清型有效,但由于快速更换血清型,这种疫苗接种的影响不太明显。在此,我们基于对成人肺炎球菌脑膜炎、侵袭性肺炎球菌感染、肺炎和胸膜肺炎、急性中耳炎和侵袭性感染的时间序列研究,介绍了法国的疗效结果。©2024作者。Elsevier Masson SAS出版。
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引用次数: 0
期刊
Journal de Pediatrie et de Puericulture
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