Clinical trials

Autism is a neurodevelopmental disorder (NDD) characterized by two key features: persistent deficits in communication and social interaction, and restricted, repetitive patterns of behavior, interests, and activities. Ninety-five percent of children aged 3 to 6 with autism spectrum disorder (ASD) have sensory peculiarities. In adulthood, this figure remains at 90%. This atypical sensory processing has been part of the DSM diagnostic criteria since 2013. Each sense can be affected by hypo- or hypersensitivity. In the continuum of this particular sensory processing, pain, which is defined as an unpleasant sensory and emotional experience, can be very present but also difficult to detect and manage. It is now established that there are other characteristics that impact pain in ASD: information processing time may be longer, referred to as "latency time," but there are also difficulties in representing the body schema and difficulties in identifying and/or interpreting perceptions. Expression may be atypical, and there may be an apparent lack of reaction to pain due to a lack of flexibility. All of these characteristics themselves vary over time (with age, the menstrual cycle, lack of sleep, fatigue, etc.), to the point that even pain specialists in pain clinics may not recognize them. It is therefore essential to carry out appropriate, individualized assessments. The scientific literature refers to the high frequency of painful events in ASD. For example, the prevalence of gastrointestinal disorders with their associated abdominal pain is significantly higher. Recent research has revealed that 82.4% of children and adolescents with ASD have at least one gastrointestinal symptom. Researchers have found that children with ASD are almost eight times more likely to have one or more chronic gastrointestinal symptoms than typically developing children. There are also more common comorbidities that facilitate or maintain chronic pain: Ehler Danlos syndrome and hypermobility spectrum disorders, IBD, ADHD, post-traumatic stress disorder, depression, migraines and tension headaches, anxiety disorders, epilepsy, small fiber pathologies, nutritional deficiencies, musculoskeletal disorders, etc. Mutations in certain genes involved in ASD (such as SCN9A, SHANK3, and CNTNAP2) lead to impaired neuronal function, producing different responses to pain, as demonstrated in both mouse and human models. The links between ASD and chronic pain are therefore complex. Sometimes it is the unusual characteristics of the pain that could lead to a diagnosis of ASD. The concept of central sensitization (CS), which underlies the type of pain known as "nociplastic," helps explain the state of pain hypersensitivity and pathologies such as fibromyalgia and irritable bowel syndrome. In 2022, Grant et al. found that 21% of adults with ASD surveyed in the cohort reported having a diagnosis of central sensitization syndrome (CSS), but 60% scored at or above the cut-off. This suggests that CS symptoms such as pain and fatigue are very common in people with autism, and perhaps more prevalent than in the general population. For example, three-quarters of women diagnosed with ASD and/or ADHD in childhood report chronic pain in adulthood. The issue is the disability associated with this chronic pain and the impairment of quality of life.

In the field of geriatrics, the Standardized Geriatric Approach (SGA) which is the benchmark for assessing elderly patients, consists of evaluating the medical, psychological and functional capacity dimensions of the elderly subject, among others. After a review of the literature, investigators were unable to find any scales that could study the ability to perform basic movements in a comprehensive and graded manner. Scores that do assess certain aspects of motor abilities are not comprehensive, and are often based on self-reporting by the elderly or their relatives : * The AGGIR grid assesses dependency on the basis of activities performed or not performed. In addition, all basic movements are grouped together in a single item, which does not provide detailed information on the capabilities of elderly people. * The ADL score assesses activities of daily living, based on what patients declare. Only one item concerns basic movements, without detailing them. * The Tinetti score and Time up and go do not assess all basic movements, and require the patient to be able to stand to provide relevant information, whereas many geriatrics patients are unable to stand. Thus, investigators created a score to assess motor abilities more comprehensively that will include the following basic movements: * Getting up in bed * Turning on one side in bed * Sitting at the edge of the bed * Stand up * Move around a small perimeter (bedroom) * Sitting up * Return to bed The main objective is to evaluate of this study is to determine the inter-rater reliability of the GRAMPA score in elderly patients hospitalized in a geriatrics department.

The time it takes for patients to be readmitted to hospital is a major public health issue, both in terms of medical time and costs. In fact, 15% of patients of all ages are likely to be re-hospitalized within a month of hospitalization. Today, hospitalizations present a significant nosocomial risk, all the more so in fragile populations. If these hospitalizations are long or repeated, it is crucial to develop solutions to reduce their number. Elderly people often have a number of complementary pathologies and frailties, which are frequently destabilized during hospitalization or on discharge. In this context of medico-social and financial stakes, a 2012 survey showed that 86% of French physicians would be prepared to make themselves available within 24-48 hours of hospital discharge if the situation justified it. Changes in medical demographics are forcing primary care physicians to adapt their practices, and the evidence of a reduced risk of re-hospitalization would make it possible to prioritize the provision of this consultation on discharge from hospital. Post-hospitalization follow-up consultations with the primary care physician are recommended, but investigators have very little data on their benefits. Investigators hypothesise that an early consultation (1 month post-hospitalization at most) by an elderly patient's primary care physician after hospitalization in geriatric medicine promotes: patient follow-up; reduced risk of re-hospitalization within 3 months. The aim of this study is to determine the association of an early consultation by the primary care physician in the month following discharge from geriatric medicine hospitalization with rehospitalization rates within 3 months.

Smoking is still a major cause of premature death in France (75,000 deaths a year). Health professionals also seem to be affected by smoking, but few studies have been carried out on this population of smokers. While having a job can be protective, certain working conditions are at risk: night shifts, stress, physical strain, burnout... In 2010, 23% of nurses and 40% of nursing auxiliaries were smokers. More recently, a study of 10,000 health professionals in a French health establishment in 2022 revealed a rate of 32% among nursing auxiliaries. Data on smoking among health professionals is still scarce. Yet they seem essential, given that smoking among healthcare professionals seems to be an obstacle to dealing with patients' consumption and contributes to the erroneous representations that persist in psychiatry more than elsewhere, such as: "smoking with a patient makes an alliance with them", "smoking is a way of reducing psychological tension", "patients have other problems to deal with", "it won't work because they've been smoking for years". Smoking in mental health facilities is high among both patients and professionals. Investigators now know that smoking has an impact on mood disorders and sleep. It aggravates all somatic and psychological pathologies and predisposes people to more diabetes, chronic bronchitis, cardiovascular disease, cancer, etc. It also interacts with many drugs. Smoking screening and cessation assistance have become an indicator of quality somatic care in mental health institutions. Investigators hypothesise that a consultation in the workplace can help employees to change their smoking habits. The aims of this study are to assess the effect of a workplace smoking clinic on smokers employed in a mental health institution, and to describe their smoking habits and profiles according to occupational category, with a view to implementing appropriate preventive and treatment measures.