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Background. The prevalence of low vision and blindness in persons across the lifespan means that occupational therapists will encounter these conditions across all areas of practice. Practitioners must be equipped with competencies necessary to recognize and respond to vision loss-related concerns. Purpose. This study sought to identify essential occupational therapy competencies when providing services to people with low vision and blindness. Method. The study employed a three-phase modified Delphi methodology administered through online surveys and focus group. Respondents included people with low vision or blindness, professionals with special expertise in low vision/blindness, and occupational therapists in other practice areas. Data were analyzed using an iterative, consensus-generating strategy involving quantitative analysis of competencies, qualitative input, and expert panel review. Findings. The process yielded a 51-item competency framework organized into six domains. Implications. The framework provides the foundation for a common curriculum for Canadian occupational therapy programs and for the creation of educational resources.

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The eyebrow is an aesthetic unit playing an important role in the balance and expression of the face. It consists of hairs whose different orientations make its complexity. The main causes of eyebrow alopecia are repeated eyebrow plucking, reduced density due to age, and post-traumatic alopecia. Follicular transplantation is a simple surgical technique that corrects most cases of eyebrow alopecia. This involves implanting hair follicles, taken from the scalp or, more rarely, from a hairy region of the body, into the bare or sparse area of the eyebrow.

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INTRODUCTION: Fournier's gangrene, a rare infectious condition affecting the external genitalia, often requires aggressive medical-surgical interventions, resulting in variable scrotal tissue loss. Despite numerous proposed reconstruction techniques, achieving a consensus on the most effective approach that balances aesthetics and function remains elusive. This case report presents a one-year follow-up on scrotal reconstruction using a pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) propeller flap. CASE REPORT: A 56-year-old patient with significant scrotal tissue loss due to Fournier's gangrene underwent scrotal reconstruction using a pedicled SCIP propeller flap. Optimal placement was ensured through a subcutaneous tunnel, with a thin thigh skin graft applied to cover the penile skin defect. DISCUSSION: The SCIP flap is distinguished by its thin and pliable characteristics, rapid harvesting and featuring a discreet donor site. It stands as a compelling alternative to skin grafts, providing advantages in sensory restoration, color congruence, and resilience against tension. Considering the thickness of the reconstruction helps both in recovering testicular function and improving the appearance by restoring the natural contour. CONCLUSION: The utilization of the pedicled SCIP propeller flap for scrotal tissue loss resulting from Fournier's gangrene has demonstrated both aesthetic and functional success, underscoring its potential as an effective reconstructive option.

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The use of technical aids has a positive impact on the autonomy and quality of life of elderly or disabled people, and is also beneficial for the caregivers and professionals who support them. Nevertheless, there are still major obstacles to their use, notably a general lack of information on technical aids. This observation led us to produce a set of information tools to help people better understand these aids and how to use them.

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While most adults confronted with the death of a loved one manage to grieve, about 10-20% of individuals develop complicated grief, characterized by persistent distress and impaired social skills, or pathological grief, defined by the onset or decompensation of a psychiatric disorder. Little is known about the biological causes of these grief complications. Recent work suggests that oxytocin, a major neuroendocrine hormone regulating many neurocognitive mechanisms, may be involved in this process. Oxytocin is widely studied and well known for its impact on the mother-child bond and hormonal and brain systems related to attachment and social interactions. In this article, we propose a neurocognitive model of grief complications based on existing data on the role of oxytocin in interpersonal attachment and its impact on brain activity. We suggest that complicated grief is associated with dysfunctional cerebral oxytocinergic signaling and persistent hyperactivation of the nucleus accumbens. This mechanism is involved in limiting the reduction of interpersonal attachment to the deceased during acute phases and in searching for new interpersonal relationships during the recovery phase. We show how the exploration of cerebral oxytocinergic signaling would improve the understanding of physiological grief mechanisms in the general population and could allow the development of new therapeutic perspectives against the complications of grief.

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OBJECTIVES: Low back pain (LBP) is one of the main expenditure items for health systems. Data on the economic impact of LBP are uncommon from the patient perspective. The aim of this study was to estimate the economic impact of work disability related to chronic LBP from the patient perspective. METHODS: We conducted a cross-sectional analysis from patients aged over 17 years suffering from non-specific LBP for at least 3 months. Systematic medical, social and economic assessments were collected: pain duration and intensity; functional disability with the Quebec Back Pain Disability Scale (0-100); quality of life with the Dallas Pain Questionnaire; job category; employment status; duration of work disability due to LBP, and income. Factors associated with loss of income were identified by multivariable logistic regression analysis. RESULTS: We included 244 workers (mean age 43 ± 9 years; 36% women); 199 patients had work disability, including 196 who were on sick leave, 106 due to job injury. Three were unemployed due to layoff for incapacity. The mean loss of income for patients with work disability was 14% [SD 24, range -100 to 70] and was significantly less for patients on sick leave due to job injury than on sick leave not related to job injury (p < 0.0001). On multivariable analysis, the probability of loss of income with LBP was about 50% less for overseers and senior managers than workers or employees (odds ratio 0.48 [95% confidence interval 0.23-0.99]). CONCLUSION: Work disability due to LBP resulted in loss of income in our study. The loss of income depended on the type of social protection and job category. It was reduced for patients on sick leave related to work injury and for overseers and senior managers.

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Presentation of the clinical situation of Mrs. M. The mobile psychiatric team of the Marchant hospital in Toulouse (31) is requested by the coordinating physician of an establishment for dependent elderly people for an evaluation of the mood with suicidal risk in this 92 year old patient who has recently entered the structure.

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The sudden loss of a parent during adolescence causes great psychological suffering in the young person as well as multiple reorganizations within the family unit. This traumatic mourning requires appropriate care that takes into consideration both the multiple and complex effects of this loss and the collective and ritual dimensions of mourning. Through two clinical cases, we will discuss the interest of a group care device to address these dimensions.

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Bone defect in the hand and wrist is the result of 3 main causes: traumatic, infectious or tumoral. Whatever the cause and possibility of emergency management, the site (hand or wrist) and anatomical location (articular or diaphyseal) guide the choice of surgical technique and timing. Functional sequelae do not vary, and the ultimate objective is not so much to fill a defect but to give a useful and accepted finger, hand or wrist.

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Gunshot-related forearm fractures are rare injuries, usually incurring bone defect. The aim of the study was to report clinical and radiological results for sequential internal fixation and bone grafting in acute civilian forearm gunshot fractures with bone defect. The procedure involves staged techniques consisting of bone debridement, soft-tissue closure and temporary intramedullary Kirschner wire fixation, followed by deferred bone grafting. To our knowledge, the present study is the first to investigate this surgical sequence in such injuries. Between June 2018 and September 2019, 6 civilian cases (5 male, 1 female) with a mean age of 26 years (range, 19-36 years) were operated on by sequential internal fixation and bone grafting for acute forearm gunshot fractures with segmental bone defect. Demographics, injury characteristics and surgical features were recorded. The Tang classification system was used to evaluate clinical and radiological results at final follow-up. Mean follow-up was 27 months (range: 21-32 months). Defect location was in the radius in 4 patients and in the ulna in 2, with a mean defect size of 3.75 cm (range, 2-8 cm). Union was achieved in 5 patients, at a mean 7 months (range, 4-10 months). Functional outcome was excellent in 4 patients, good in 1 and fair in 1. Sequential internal fixation and bone grafting seems a reliable option in the treatment of acute forearm gunshot fractures with bone defect. LEVEL OF EVIDENCE: Level IV - Retrospective study.

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PURPOSE: The sural flap has often been used to cover the weight-bearing and non-weight-bearing areas of the foot and ankle. This study reports our experience in the coverage of these defects in the foot in weight-bearing areas. PATIENTS AND METHOD: This is a retrospective and descriptive study of 70 months. This study includes 16 patients presenting a loss of plantar substance and/or heel of the foot covered by a sural flap with a distal pedicle. The sampling technique described by Masquelet served as our reference. An increase in the length of the pedicle of at least two centimeters during the dissection made it possible to avoid any stretching or compression for the most distal lesions. RESULTS: The average age was 35 years with a sex ratio of three in favor of men. Traumatic lesions predominated (n=10) with an average area of lesions of 68.8cm2. The average partial and total support times were 1.8 and 3.6 months respectively. We noted one case of flap necrosis. The natural evolution of the flap took place in three progressive stages: regeneration, keratinization and squamous metaplasia. Normal bipodal support and stable gait without footwear anomaly were noted in 15 cases. CONCLUSION: The distal pedicle sural flap technique is accessible. Its reliability makes it an ideal choice for distal loss of substance to the leg and foot.

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OBJECTIVE: This work aims to report the modalities of management of maxillofacial substance loss following trauma in our context. METHODS: This was a descriptive cross-sectional study with retrospective data collection of 55 cases of maxillofacial substance loss of traumatic origin over a period of 7 years from 2014 to 2020 in the department of stomatology and maxillofacial surgery of Yalgado Ouedraogo University Hospital. RESULTS: The annual prevalence was 7.86 cases. The etiology was dominated by road traffic accidents (80% of cases). Loss of labial substance was the most frequent (58.18%). The lesions were severe, Lakmann type IV in 76.36% of cases. Bone loss occurred in 9.10% of the cases and was mainly located in the mandible. The repair of substance losses by locoregional flaps was the main technique for soft tissue reconstruction. Bone defects were repaired with non-vascularized bone grafts. The evolution was satisfactory in the majority of cases (80.3%). Infections were the main complications (5 cases) and the sequelae were dominated by unaesthetic scars (45.45%). CONCLUSION: The management of maxillofacial substance loss of traumatic origin must be early and adequate for a better aesthetic and functional result.

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OBJECTIVES: Diabetes can lead to loss of protective sensation (LOPS) in the feet. Identifying LOPS requires use of screening tests, such as the standard monofilament test (SMT) and the Ipswich Touch Test (IpTT). The aim of this validation study was to compare the SMT (criterion) with the IpTT (new test). METHODS: Each participant was randomly tested using the SMT, IpTT and Neuropathy Disability Score to identify LOPS. Sixteen health-care providers assessed 8 participants in randomized order using a specific protocol. RESULTS: The IpTT, compared with the SMT, demonstrated a specificity of 100% for all raters and a mean sensitivity of 93.8% for LOPS. Kappa coefficient was 0.97 for SMT and 0.83 for IpTT. CONCLUSIONS: The IpTT can be used by health-care providers as an effective tool for screening for LOPS in people with diabetes. This study validated the IpTT to the SMT in identifying LOPS.

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OBJECTIVES: To study the coverage period influence and various parameters concerning the microsurgical act on the patient clinical outcomes. METHODS: We report 23 cases of reconstruction of lower limb loss of substance by free flap operated from 2010 to 2021. Among them, 9 patients were operated on as an emergency versus 14 in the secondary or late phase of the trauma. RESULTS: The average age of injured patients operated on emergency was 42 years (17-68 years) and 34 years for the patients who undergo deferred surgery (17-57 years). The sex ratio (female/male) was 22% in patients operated on urgently and 7% in patients operated on later. Regarding the type of free flap, it was Serratus anterior muscle flap in 10 cases, Latissismus dorsi flap in 9 cases, ALT flap in 3 cases and Gracilis muscle flap in 1 case. There were 2 failures of vascularized free transfer (8.7%) with complete necrosis of the flap and 3 revision surgeries on venous thrombosis which finally made it possible to obtain 3 flap successes. We analyze the results (complications/osteitis) according to the time to coverage. CONCLUSIONS: In our study, we did not find any significant difference between the groups operated in emergency and at a distance concerning the rate of infection and failure of the flaps.

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INTRODUCTION: A farm belonging to a Swiss sow pool system reported increased cases of necrosis on the base of the tail or ears in their piglets. Therefore, herd examination was performed in February 2021, and it was found that about half of all examined litters included piglets with necrosis of different locations, and that the sows of these piglets were rather thin. Upon instruction, the farmer then documented the body condition score (BCS) and weight before farrowing and after weaning, and the number of liveborn piglets affected by necrosis of the tail or ear of the next four farrowing batches. In total, data of 97 sows with 1214 liveborn piglets were evaluated. Sows were retrospectively allocated into two groups: Those with piglets with ear and/or tail necrosis (NE), and those without (WN). Of the 97 litters, 40 included piglets with necrosis, with 28 of them having piglets only with tail necrosis, 8 only with ear necrosis, and 4 litters included piglets with both types of necrosis. The group NE lost significantly more weight and BCS points over the suckling period than the group WN, with a tendency of having a lower BCS after weaning (2,0 vs. 2,25/5,0). Blood samples of five sows were analyzed and tested positive for the Fusarium mycotoxin deoxynivalenol (DON). It could be possible that the sows previously consumed DON contaminated feed, which was then stored in their fat tissue, and released again into the blood stream during increased weight loss. Since DON can be transferred from the sow to her piglets during gestation or lactation, this release might have affected the piglets, leading to tail or ear necrosis. However, causative studies are needed to confirm this hypothesis.

INTRODUCTION: Une exploitation appartenant à un système suisse de pool de truies a signalé une augmentation des cas de nécrose à la base de la queue ou des oreilles chez ses porcelets. Par conséquent, un examen de l'effectif a été effectué en février 2021 et il a été constaté qu'environ la moitié de toutes les portées examinées comprenaient des porcelets présentant des nécroses à différents endroits et que les mères de ces porcelets étaient plutôt maigres. Sur instruction, l'éleveur a ensuite documenté la note d'état corporel (BCS) et le poids avant la mise bas et après le sevrage, ainsi que le nombre de porcelets nés vivants affectés par une nécrose de la queue ou de l'oreille des quatre lots de mise bas suivants. Au total, les données de 97 truies avec 1214 porcelets nés vivants ont été évaluées. Les truies ont été réparties rétrospectivement en deux groupes : Celles dont les porcelets présentaient une nécrose de l'oreille et/ou de la queue (NE), et celles qui n'en présentaient pas (WN). Sur les 97 portées, 40 comprenaient des porcelets atteints de nécrose, dont 28 uniquement avec une nécrose de la queue, 8 uniquement avec une nécrose de l'oreille et 4 avec les deux types de nécrose. Le groupe NE a perdu beaucoup plus de poids et de points BCS pendant la période d'allaitement que le groupe WN, avec une tendance à avoir un BCS plus faible après le sevrage (2,0 vs. 2,25/5,0). Les échantillons de sang de cinq truies ont été analysés et se sont révélés positifs pour la mycotoxine de Fusarium, le déoxynivalénol (DON). Il est possible que les truies aient consommé des aliments contaminés par le DON qui a ensuite été stocké dans leur tissu adipeux puis libéré dans le sang lors de la perte de poids. Comme le DON peut être transféré de la truie à ses porcelets pendant la gestation ou la lactation, cette libération pourrait avoir affecté les porcelets, entraînant une nécrose de la queue ou des oreilles. Cependant, des études causales sont nécessaires pour confirmer cette hypothèse.

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INTRODUCTION: Age-related macular degeneration (ARMD) is the leading cause of blindness in western countries. Along with decrease in vision, ARMD patients, who are often elderly, carry an increased risk of developing depression and Charles-Bonnet syndrome (CBS). However, these disorders remain under-diagnosed. Detection and treatment could considerably improve their quality of life. The aim of our study is to evaluate the relevance and feasibility of systematic screening for depression and CBS in AMD patients. MATERIALS AND METHOD: Patients with ARMD, who showed up to the ophthalmology department of CHU Brugmann (Brussels, Belgium, Université Libre de Bruxelles) over a 4-week period, were asked to measure their depression score using the Geriatric Depression Scale (GDS-15) and to complete a questionnaire on CBS. RESULTS: In total, 112 patients were recruited. One hundred and six responded to the GDS-15 score; among them 70 patients (66.04%) suffered from depressive symptoms. A multivariate analysis highlighted three risk factors: decreased vision in the better eye (P=0.023), unilateral impairment (P=0.024) and social isolation (P<0.001). One hundred and twelve patients completed the CBS questionnaire, no new diagnoses were made. Six of the 112 patients (5.7%) knew about CBS. CONCLUSION: Screening through the GDS-15 depression score should be performed systematically in all ARMD patients. It is important not to overlook psychosocial factors in those patients. In our study, more than two thirds of patients suffer from unrecognised depressive affects. Early detection and adequate treatment could significantly improve their quality of life and compliance. As far as CBS is concerned, given its low prevalence, objective criteria should be established in order to select the patients who need screening.

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Qualitative research conducted in Quebec aims to trace the psychosocial profile of immigrants in a vulnerable situation due to their migratory journey and to identify the challenges of the actors involved in their integration process. The participants in the research are enrolled in a francization program specific to Quebec for immigrants with low literacy skills (Foreign Investment Promotion and Protection Agreement). The results raise several issues related to the grief and loss experienced by the most fragile immigrants. Indeed, the challenges of post-migration life and integration into the host society are added to the many migratory losses and the suffering of ongoing grief.

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Pain, mourning translate, in their indeterminacy of the affective experience, the suffering, the guilt, the anguish when the individuals are confronted with the death, the loss or the separation from the object. It doesn't matter if this object is a loved one or an abstraction... These different experiences each sign in their own way the human way of reacting to the inescapable encounter with this reality. To seize and overcome the experience of the affective experience makes it possible to understand and to put in form the significant mechanisms which underlie the processes of mourning. It also helps to apprehend its necessary and obligatory scope, given the attachment and identification that characterize the link between humans.

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In view of the major psychological issues that characterize the mourning process, a system has been working for about ten years in a group of health and medico-social institutions to support caregivers. The institutional intervention unit, composed of specially trained psychologists, offers discussion groups for these teams who have been confronted with the sometimes very brutal experience of loss and accompanies them towards the resumption of a mourning process. Based on group psychodynamic approaches, the reasons that can hinder the stages of mourning in these groups and the effects of the proposed discussion groups are explored.

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PURPOSE: To evaluate the Meibomian glands and presence of dry eye in patients with unilateral pseudoexfoliation. METHODS: The study included 32 patients with clinical pseudoexfoliation (PEX) in one eye and 30 controls. Schirmer and tear film break-up time (TBUT) tests were performed, along with a detailed ophthalmological examination, meibography and evaluation of areas of meibomian gland loss. Subjective symptoms were evaluated using the ocular surface disease index (OSDI). RESULTS: Schirmer test results for eyes with or without PEX were similar (10.438±4.47mm and 11.563±4.35mm, respectively), vs. 15.967±9.75mm in the control group. While measurements of TBUT were found to be similar in both eyes of the patient group (6.188±2.66s in eyes with PEX and 6.250±1.87s in eyes without PEX), this was 8.233±2.66s in the control group. Schirmer and TBUT test results were found to be significantly lower in both eyes of patients with unilateral pseudoexfoliation compared to control eyes. The rate of meibomian gland loss in the upper and lower eyelids in the patient group was found to be significantly higher than in the control group. Similarly, meiboscores of both eyelids in the control group were significantly lower than those in patient group; however, there were no differences between patient eyes with or without pseudoexfoliation. CONCLUSION: The patients with unilateral pseudoexfoliation had a significant loss of meibomian gland area in both eyes compared to the control group, and their meiboscore was higher. It should be considered that meibomian gland loss may be one of the causes of dry eye in patients with pseudoexfoliation.

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