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Since the publication of the law of 18 January 1994, health care for detainees has been entrusted to public health establishments, and no longer to the prison administration. This is a real step forward insofar as individuals placed in the hands of justice now benefit from care provided by health professionals, who officiate within health units in prisons. Today, these professionals work in particular to promote preventive and health promotion actions, thereby helping to restore the detainee's place as a subject with a view to reintegrating him or her into the community., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Purpose: In case of xenobiotics induced toxic deaths analyzed at the university hospital of Rennes, a multidisplinary team of forensic analysts, toxicologists, anatomopathologists and pharmacologists assess xenobiotics' contribution to the death., Methods: A death contribution score (SCRIM) is collectively established during meetings for each death involving xenobiotic drugs. Graded between 1 and 6, lower was this score, more certain was the imputability. Among deaths with the highest imputability, drug poisonings were isolated., Results: Analysis of 266 deaths presented at meetings over the period 2010-2017 highlight a lot of drug medicine poisonings (60%). The main classes implicated are: opioid substitution treatments (24%) followed by anxiolytics (23%), antidepressants (16%), legal opioids (16%) and antipsychotics (14%). Analysis of these cases by Rennes regional pharmacovigilance center permits to obtain a qualitative signal by establishing a local overview of the main risk classes but also to highlight a specific signal, in particular for oxycodone and antihistamines., Conclusions: This multidisciplinary approach shows that a majority of toxic deaths are attributed to drugs. Mortality attributed to oxycodone and antihistamines is a specific signal that should be closely monitored., (Copyright © 2019 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

France has adopted a new firearms regulation. Firearms are now classified into four categories (A, B, C, and D). The administrative procedure for acquisition and possession of firearms of categories B and C requires medical advice. The medical certificate must be dated less than a month, and detail a state of health compatible with the acquisition and possession of a firearm. There are no guidelines mentioning the conditions that can lead to incompatibility. Compatibility does not apply to the handling and use of the firearm. If the applicant is undergoing or has undergone treatment in a psychiatric institution, he must also produce a medical certificate issued by a psychiatrist. The hunting license application requires a medical certificate mentioning a state of physical and mental health compatible with the possession of a firearm. Its validity is acquired for life. The practice of shooting sports or skeet requires an annual medical certificate of non-cons in reference to the rules of sports federations., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: For the last decades, many researchers have focused on paranormal beliefs. Beliefs in the existence of paranormal phenomena would be common and studies conducted in westernized countries have highlighted a high prevalence of individuals believing in the existence of such phenomena. Tobacyk and Milford (1984) developed the Revised Paranormal Belief Scale (RPBS) for assessing beliefs in paranormal phenomena. This 26-item self-reported questionnaire, measuring beliefs in phenomena such as witchcraft or superstition, is one of the most widely used questionnaires to assess such beliefs. While studies focusing on paranormal beliefs tend to develop, there is no French self-report instrument to assess this construct. Researchers have tried to identify specific variables that might be linked to such beliefs, and some have focused on personalities of individuals who believe in the paranormal. Schizotypy has been reported to be significantly and positively correlated with paranormal beliefs., Objectives: The aim of this study was a) to validate the French version of the RPBS and b) to explore the relationship between Schizotypal Personality Disorder traits and paranormal beliefs., Methods: After being recruited using the Internet and social networks (e.g. facebook), a sample of 313 participants (mean [SD] age=31.12 [11.62]; range 18-58years) completed the Schizotypal Personality Questionnaire (SPQ-B), assessing Schizotypal Personality Disorder traits and the Revised Paranormal Belief Scale assessing paranormal beliefs., Results: Confirmatory factor analysis (CFA) was conducted to test the proposed 7-factor structure of the RPB developed by Tobacyk. Several adjustment indices were used to evaluate the model. As the first model did not fit the original one, others models were tested. Our findings indicated that a seven-factor solution, excluding 2 items, best described the item structure: (1) spiritualism, (2) superstition, (3) witchcraft, (4) precognition, (5) traditional religious belief, (6) psi, (7) and extraordinary life forms. Relationships between paranormal beliefs and Schizotypal Personality Disorder traits were also explored. Correlations between some subscales of the SPQ-B and some dimensions of the RPBS were found. The "cognition-perception" subscale was strongly correlated with the "witchcraft", "spirituality", "precognition" and "psi" subscales. Nevertheless, this subscale was lightly correlated with the "traditional religious belief" and "extraordinary life forms" dimensions. No correlation was found between the others dimensions of schizotypy as "disorganized" and "interpersonal" and dimensions of paranormal beliefs., Discussion: The initial model developed by Tobacyk and Milford did not fit the data from the French population. The low internal consistencies regarding both superstition and extraordinary life forms dimensions highlighted some cultural differences that have to be acknowledged. This result emphasizes that beliefs in some extraordinary life forms as Loch Ness monster are not an important dimension to take into account in a French population. Our findings also indicate that the RPBS is a valid and reliable instrument for assessing paranormal beliefs in a French population. Our findings also highlight that such beliefs are associated with Schizotypal Personality Disorder traits. Developing research on the association between Schizotypal Personality Disorder traits and such beliefs appears of prime importance. Future studies focusing on features associated with paranormal beliefs are also warranted., (Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Unlabelled: Court-ordered treatment was created in 1998, as part of a law against sexual offense recidivism. The creation of court-ordered treatment is based on the premise that many offenders have psychiatric disorders. If the court-ordered treatment is appraised as an effective way to prevent recidivism by the lawmaker, the preeminent role of psychiatry, in the prevention of recidivism has generated controversy in the psychiatric community. Few studies have been conducted on court-ordered treatment in France, and have concerned epidemiological measures. Court-ordered treatment leads to an extension of the expert's mission. In order to prevent recidivism, the interest of a treatment is a new part of the expert's mission., Purpose: The main purpose of this study was to assess the kind of diagnosis reported by the forensic psychiatrist who considered the court-ordered treatment as appropriate., Method: We led a descriptive and retrospective study among the experts' reports of 68 subjects followed by three psychiatrists. We categorized each diagnosis found in the experts' reports in reference to DSM-IV-TR axis I and axis II. As the expert has no obligation to refer to the DSM-IV-TR, we also considered the "no DSM-IV-TR categorized disorder" as a category. The primary outcome was the proportion of each diagnosis category in experts' reports, in which the forensic psychiatrist agreed with the indication of a court-ordered treatment., Results: We analysed 123 experts' reports in which the mission was to diagnose a mental disorder and to assess the need for a court-ordered treatment. The expert agreed with the need for a court-ordered treatment in 112 reports. In those reports the diagnosis was "no disorder" in 27% of them, "no DSM-IV-TR categorized disorder" in 26% of them, "axis II disorder" in 24% of them, "axis I disorder" in 19% of them, and "association of an axis I and an axis II disorder" in 4% of them., Discussion: The diagnoses were heterogeneous. Their associations with the need for a court-ordered treatment seem to be contradictory when considering the association between "no mental disorder" and "need for a court-ordered treatment" found in 27% of the reports. These paradoxical results led us to question the meaning of mental disorder and treatment., (Copyright © 2013 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Cases of multiple sclerosis appearing after a mass hepatitis B vaccination program can lead to claims for compensation. The legal jurisdiction under which such claims will be examined depends on whether the vaccination was carried out as part of a mandatory program (implying liability of the State or employers) or in application of recommendations (implying responsibility of the vaccine manufacturer). In the literature, there is no evidence demonstrating a statistically significant relationship between anti-hepatitis B vaccination and the onset or exacerbation of multiple sclerosis, questioning even the notion of compensation. The analysis of the jurisprudence shows that, in a first period, the scientific uncertainty of a link between vaccination and onset of multiple sclerosis precluded any compensation to victims. Subsequently, judicial and administrative courts ignored this scientific uncertainty, which enabled them to examine claims for compensation by adopting a presumptive reasoning based on specific criteria and different regulations depending on the legal jurisdiction. According to the French high courts (Cour de cassation and Conseil d'État) scientific causality and legal causality do not necessarily have to be consistent, such that medical uncertainty should not be an obstacle to compensation for victims., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: Shaken baby syndrome (SBS) is defined by the association of intracranial hemorrhage and retinal hemorrhage in infants under 2 years of age, with no obvious external trauma. This syndrome leads to frequent neurological sequelae. Therefore, these infants can claim compensation for damage if sequelae are directly and irrefutably linked to the trauma. Data on the judicial treatment are for the most part inexistent in the medical literature, the reason for which this study was conducted., Population and Methods: We conducted a retrospective study over a period of 10 years. We included all cases of SBS reported to the High Courts of the Ille-et-Vilaine department (Rennes and St Malo). The cases were listed from the archives of the Department of Medical Information, the Specialized Unit for Abused Children and Forensic Department at the Rennes University Hospital. We were able to look the judicial cases up after receiving agreement from the prosecutors of the two courts., Results: Of the 34 cases included, 12 could not be used (lost, ongoing, destroyed, transferred to another court), 16 led to an order of dismissal or to no further action because of an unknown perpetrator, insufficiently described offense, or insufficient evidence. Six authors were sentenced. It was the father (n=5) or the childminder (n=1). All perpetrators had confessed to part or all of the charges brought against them. Five children received compensation: three by the civil court and two by the commission of compensation for victims of an offense., Conclusion: Most cases led to no conviction and no compensation. The identification by the physician of the person responsible for the lesions in SBS does not mean that the perpetrator will be convicted because of the strict application of criminal law. The nomination of an administrator representing the infant could resolve the lack of compensation., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: Clinicians are regularly confronted with the question of refusal of treatment from patients with tuberculosis. For several years, the French public health authorities have been studying the possibility of compelling treatment or isolation, but no plan has been implemented even though European and American experiences have shown the effectiveness of restrictive measures., Background: Neither the statutory exceptions to the principle of consent to medical treatment nor the conditions of implementation of "required care" allow legally binding measures against patients refusing care or isolation., Viewpoints: The legislation on serious health threats has recently been applied to the situation of a refusal of treatment in the context of tuberculosis. It allowed the patient to be ordered to observe prescribed care and the possibility of forced isolation in the event of breach of this order., Conclusions: The legislation on serious health threats is a response to the question of refusal of treatment from patients with tuberculosis. However the opinion of the legal authority as to its necessity and proportionality to the risk remains unknown., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Study Aim: The aim of this study was to describe the treatment of symptomatic knee cartilage defects on young active patients by autologous chondrocyte implantation and to report preliminary results in 24 patients., Patients and Methods: Since April 1996, 24 selected patients underwent 25 implantations in five military hospitals. There were 19 men and five women (all of them practicing sports); mean age was 27. Lesions were localized on left (n = 13) and right (n = 12) aligned and stabilized knees. There were 12 isolated cartilage defects (eight OCD and four posttraumatic) and 13 associated with ligament lesions (n = 8) or multiple and severe lesions (n = 3 indication of salvage). Mean surface of cartilage defects was 6 cm2. Mean preoperative evolution was 11 months and stage was grade IV (Outerbridge) for all. The first step was arthroscopy for classification and biopsy. The second one was implantation after a 3-week delay (for the ex vivo culture) through arthrotomy, under a periosteal flap taken from tibia and sutured on the edges of the prepared defect. Weight bearing was allowed after the 6th week; MRI was performed at 6, 12, 18, 24 months. The follow up was evaluated with three scales: Lysholm 2, Tegner Activity, Cincinnati Knee Rating System., Results: Postoperative complications included: algodystrophy (n = 2) and phlebitis (n = 1). Four patients were revised at 6 months, seven between 6 and 12 months, 11 after. The longest follow-up was 26 months. Results were poor in one patient (salvage). For the others, pain and swelling decreased after 6 months and disappeared after 12 months., Conclusion: Autologous chondrocyte implantation used in this senes and in a large international ongoing series seems to be the only procedure allowing a true long-term regeneration of cartilage defects. Some questions remain, on the biological level in relation with the use of some growth factors and the risk of chromosomic abnormalities, and on the economical level because of the high cost of this technique.

A 24-year-old man presented with a painful and invalidating coccyx. Exploration revealed a bony lesion involving parts of 2nd and all of the 3rd coccygeal vertebrae. The pathology examination of the surgical specimen revealed the diagnosis of benign osteoblastoma of the coccyx. This exceptional localization required complete surgical resection going into healthy tissues to allow a full histological study and to ensure the absence of relapse. Post-operative follow-up was uneventful and the functional result was excellent.

Ten cases of nonunion of the hook of the hamate were observed, eight of which had occurred during athletic activity. The mean age was 31.1 years and the mean length of time between the accident and diagnosis was 8.8 months. Diagnosis was most often confirmed by CT scanning, which, represents the examination of choice. In all cases, surgical treatment was applied using the same technique and the same surgeon. Results were evaluated according to resolution of pain, movement, strength of grip and return to former level of athletic activity. Results were very good in six patients and good in two others who returned to previous activity. One patient had only a fair result with resolution of pain. One case was a failure with persistence of pain and ulnar paralysis.

Darier and Ferrand dermatofibroma is a rare skin tumour arising in the dermal connective tissue. It has a slow course over several years and presents very unusual histological features. It is characterised by a marked potential for local recurrence, frequently multiple due to insufficient primary resection. It has a very low metastatic potential. Its diagnosis is difficult but essential in order to perform an appropriate surgical procedure which ensures its excellent prognosis.