1
|
Chakraborty PK, Chaudhury S, Chaudhari B, Hussain M, How SL. Impact of clinical rotational posting on attitude toward psychiatry of undergraduate medical students in Malaysia. Ind Psychiatry J 2023; 32:S42-S47. [PMID: 38370974 PMCID: PMC10871408 DOI: 10.4103/ipj.ipj_215_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/19/2023] [Accepted: 06/28/2023] [Indexed: 02/20/2024] Open
Abstract
Background Almost all over the world, psychiatry training of undergraduate medical students has been criticized to be deficient in imparting required knowledge and improving the perception of students towards psychiatry and psychiatric treatment. Considering the large mental health need gap in the community, it is essential to improve undergraduate students' attitude toward psychiatry. Aim Hence, this study was planned to study the impact of psychiatry clinical posting on attitude toward psychiatry of undergraduate medical students. Materials and Methods Undergraduate medical students undergoing psychiatry posting were assessed on the first and last day of clinical posting with the help of semi-structured proforma consisting of sociodemographic information, favored future career choice, the relevance of psychiatry to their future careers, the usefulness of particular knowledge and skills, the value of knowledge of psychiatric specialties and the utility of different settings for learning psychiatry. Results After their clinical posting, students had a more positive attitude towards the usefulness of psychiatry knowledge in future general practice and the usefulness of psychiatry knowledge from undergraduate training in the future. Knowledge of alcohol withdrawal management, detection and management of delirium, and Mental Health Acts were perceived more essential in the future. Also, specialties such as deaddiction and child and adolescent psychiatry were felt more useful in future practice. After posting, students perceived that psychiatry can also be learned at medical and surgical wards as well as during home visits. However, despite some positive changes in attitude toward psychiatry, there was no significant change in choosing psychiatry as a career by the students after posting. Conclusion Undergraduate psychiatry training during clinical posting was able to make some positive changes in the knowledge and attitude of students. However, still, there were lacunae in some areas of concern. Preference of psychiatry as a branch of specialization was not increased after posting. This indicates the need for better reforms in psychiatry education at the undergraduate level to improve the perception of undergraduate students about psychiatry.
Collapse
Affiliation(s)
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D Y Patil Medical College Hospital and Research Centre, Dr. D Y Patil University, Pimpri, Pune, Maharashtra, India
| | - Bhushan Chaudhari
- Department of Psychiatry, Dr. D Y Patil Medical College Hospital and Research Centre, Dr. D Y Patil University, Pimpri, Pune, Maharashtra, India
| | - Mohd Hussain
- Department of Psychiatry, MAHSA University, Petaling Jaya, Malaysia
| | | |
Collapse
|
2
|
Bouyssi A, Prebois S, Rougé-Bugat ME, Dupouy J, Driot D. [Stigmatisation of patients with mental disorders by medical interns specialising in general practice: A national survey]. L'ENCEPHALE 2023; 49:65-71. [PMID: 36253178 DOI: 10.1016/j.encep.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The objective was to assess the level of stigmatisation of psychiatric patients by medical interns specialising in general practice (GP), and to assess the influencing factors of stigmatisation. METHODS A national survey was carried out among interns in general practice (GP) contacted through their local associations from December 10, 2019 to March 9, 2020. An online questionnaire was diffused. The validated French version of the Mental Illness Clinicians' Attitudes (MICA) was used to measure stigmatising attitudes towards psychiatry and persons with psychiatric disorder by the interns. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness with scores ranging from 16 to 96 (the most stigmatizing). Several covariates were collected: socio-demographics, personal experiences with mental health, and mental health trainings during medical studies. All questionnaires were strictly anonymized. Comparative analyses of the MICA score by group were performed using Student's tests. RESULTS A total of 389 interns responded. The majority of respondents were female (n=277; 71%) and the mean age was 27years [standard deviation (SD)±2.39]. The mean MICA rate was 40.64 (SD±8.09) for a neutral score of 56, reflecting low overall stigmatizing attitudes. MICA scores were significantly lower among female interns (40.11 vs. 41.95; P=0.042), those who had benefited from personal psychological or psychiatric support (38.70 vs. 41.61; P=0.001), and those who had completed a psychiatric externship (39.47 vs. 42.16; P=0.001). CONCLUSIONS GP interns had an attitude that is generally not very stigmatizing even if its improvement should still be sought. This is particularly verified among those who have completed a psychiatric internship during their externship. This suggested association should be supported by other studies. The stakes are high for the future management of patients since stigmatisation by a physician is strongly implied in the worse healthcare management of patients with psychiatric disorders, leading them to a shorter lifespan.
Collapse
Affiliation(s)
- A Bouyssi
- Département universitaire de médecine générale, université Paul-Sabatier Toulouse III, 133, route de Narbonne, 31062 Toulouse, France
| | - S Prebois
- Centre hospitalier universitaire Toulouse Purpan, service de psychiatrie, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - M-E Rougé-Bugat
- Département universitaire de médecine générale, université Paul-Sabatier Toulouse III, 133, route de Narbonne, 31062 Toulouse, France; UMR 1295 CERPOP Inserm, université Paul-Sabatier, 37, allées Jules-Guesde, 31000 Toulouse, France
| | - J Dupouy
- Département universitaire de médecine générale, université Paul-Sabatier Toulouse III, 133, route de Narbonne, 31062 Toulouse, France; UMR 1295 CERPOP Inserm, université Paul-Sabatier, 37, allées Jules-Guesde, 31000 Toulouse, France
| | - D Driot
- Département universitaire de médecine générale, université Paul-Sabatier Toulouse III, 133, route de Narbonne, 31062 Toulouse, France; UMR 1295 CERPOP Inserm, université Paul-Sabatier, 37, allées Jules-Guesde, 31000 Toulouse, France.
| |
Collapse
|
3
|
Brahmi L, Amamou B, Ben Haouala A, Mhalla A, Gaha L. Attitudes toward mental illness among medical students and impact of temperament. Int J Soc Psychiatry 2022; 68:1192-1202. [PMID: 35147058 DOI: 10.1177/00207640221077551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mental health-related stigma is a serious problem that has undesirable consequences for individuals with mental disorders including physical health disparities, increasing mortality, and social dysfunction. Besides, these individuals frequently report feeling 'devalued, dismissed, and dehumanized' when encountering health professionals who are also perpetrators of stigmatizing attitudes and discriminatory behaviors. AIMS The present study concentrates on attitudes, and behavioral responses of medical students and junior doctors toward individuals with a mental illness and explores factors associated with stigma including temperament. METHODS A cross-sectional study was conducted among medical students and junior doctors from medical schools of universities in Tunisia. All participants were invited to complete a brief anonymous electronic survey administered on the google forms online platform. Data were collected using self-administered questionnaires, Stigma Measurement, Mental Illness: Clinicians' Attitudes (MICA), Assessment of Affective Temperament, TEMPS-A scale. RESULTS A total of 1,028 medical students and junior doctors were recruited. The completion of a psychiatry clerkship for medical students didn't improve significantly the level of stigma toward people with a mental illness. Students in the fourth year had significantly the lowest MICA scores comparing to other students. Psychiatrists had significantly lower scores of explicit stigma attitudes than the other groups (Mean score = 0.42). As for other specialties, surgical residents had more stigmatizing attitudes than those who had medical specialties. 70% of participants believed that people with a mental illness are more dangerous than the other patients. Hyperthymic temperament was significantly associated with decreased stigma attitudes toward patients with mental illness. CONCLUSION A combination of medical school experiences of psychiatry's theoretical learning and clerkship and wider societal beliefs are important factors that shape students. Awareness of this will enable educators to develop locally relevant anti-stigma teaching resources throughout the psychiatry curriculum to improve students' attitudes toward mental illnesses.
Collapse
Affiliation(s)
- Lina Brahmi
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Badii Amamou
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Amjed Ben Haouala
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Ahmed Mhalla
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Lotfi Gaha
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| |
Collapse
|
4
|
Giralt Palou R, Prat Vigué G, Romeu-Labayen M, Tort-Nasarre G. Analysis of Stigma in Relation to Behaviour and Attitudes towards Mental Health as Influenced by Social Desirability in Nursing Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063213. [PMID: 35328900 PMCID: PMC8955242 DOI: 10.3390/ijerph19063213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 01/24/2023]
Abstract
The training undergraduate nursing students receive, both in terms of theoretical input and clinical practice, may help to instil a less stigmatising perception of mental health. To analyse the perceived evolution of attitudes and expected behaviours, a longitudinal repeated measures study was conducted in a population of student nurses during their undergraduate mental health education. The Mental Illness: Clinicians’ Attitudes Scale, a Scale for measuring attitudes to the mentally ill among future Health workers, and the Reported and Intended Behaviour Scale were completed. A mixed linear model was used to assess the effect of each factor in the questionnaires before and after the various stages of the students’ training in mental health. The overall effect of each factor was assessed by testing the interaction between factor and group, both with and without adjustment with the Social Desirability Scale. The results showed that the clinical practice stage, due to the proximity to care for people with mental health problems, improves attitudes and behaviours towards mental health in students who have not had mental health problems, and also in younger students. In conclusion, integrated, holistic training during the period of clinical practice was associated with positive changes in the attitudes and intended behaviour.
Collapse
Affiliation(s)
- Rosa Giralt Palou
- Faculty of Nursing and Physiotherapy, University of Lleida, 25003 Lleida, Spain;
- SaMIS Group, Division of Mental Health, Althaia Foundation-UVic, 08243 Barcelona, Spain;
- Correspondence: or
| | - Gemma Prat Vigué
- SaMIS Group, Division of Mental Health, Althaia Foundation-UVic, 08243 Barcelona, Spain;
| | - Maria Romeu-Labayen
- Adult Mental Health Center Horta Guinardo, Department of Public Health, Mental Health and Mother-Infant Nursing, University of Barcelona, 08007 Barcelona, Spain;
| | - Glòria Tort-Nasarre
- Faculty of Nursing and Physiotherapy, University of Lleida, 25003 Lleida, Spain;
- Health Education Research Group, Nursing and Phisioterapy Department, University of Lleida, 25003 Lleida, Spain
| |
Collapse
|
5
|
Stigmatizing attitudes and social perception towards mental illness among Moroccan medical students. Encephale 2022; 49:275-283. [DOI: 10.1016/j.encep.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 11/20/2022]
|
6
|
Rezvanifar F, Shariat SV, Shalbafan M, Salehian R, Rasoulian M. Developing an Educational Package to Improve Attitude of Medical Students Toward People With Mental Illness: A Delphi Expert Panel, Based on a Scoping Review. Front Psychiatry 2022; 13:860117. [PMID: 35360140 PMCID: PMC8964120 DOI: 10.3389/fpsyt.2022.860117] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/16/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The importance of stigma toward patients with mental illness in medical students as future physicians cannot be overemphasized. There is currently no formal training to reduce stigma toward mental illness in medical students in their educational curriculums in Iran like most other low and middle income countries. Therefore, aiming to provide a practical and effective training package focused on reducing stigma toward patients with mental illness in medical students, the current study conducted, as an expert panel with Delphi method, based on a scoping review, to develop an education package to improve attitude of medical students toward patients with mental illness. MATERIALS AND METHODS We surveyed the available international databases including PubMed, Google Scholar, Scopus, PsycINFO, Tripdatabase, Web of Science, Cochrane Database of Systematic Reviews as well as Persian databases including Iranmedex, SID, Irandoc and Magiran in February and March 2020. After an extensive review of related resources, 13 articles met our inclusion criteria. Then, we extracted the related data including type and duration of the interventions, sample size, mean and standard deviation of stigma scores before and after interventions. To develop the package among the included interventions, we asked 16 experts in psychology, psychiatry, and social medicine to rate the interventions based on a number of variables such as effectiveness, feasibility and applicability in a Delphi process. RESULTS The selected intervention in Delphi method with consensus of experts included a set of four sequential interactive interventions: showing a movie and discussing it, psychiatric training including contact with people who affected psychiatric disorders, social communication with people who affected psychiatric disorders, and group discussion on defining stigma and personal experiences. CONCLUSION In the present study, we recommend a set of interventions to reduce stigma toward patients with mental illness among medical students in the form of a package of combined, interactive and sequential interventions that have been previously been shown to be effective in reducing stigma related to mental illness. We expect that implementation of these interventions would reduce mental illness stigma in medical students; which needs further verification.
Collapse
Affiliation(s)
- Farahnaz Rezvanifar
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Vahid Shariat
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shalbafan
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Razieh Salehian
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Rasoulian
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Clément A, Delage R, Chollier M, Josse L, Gaudry S, Zahar JR, Baubet T, Degos B. Prospective study on a fast-track training in psychiatry for medical students: the psychiatric hat game. BMC MEDICAL EDUCATION 2020; 20:373. [PMID: 33076891 PMCID: PMC7574431 DOI: 10.1186/s12909-020-02304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/10/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND While medical students are losing interest in lectures in favor of other educational materials, many studies suggest the benefit of active learning, combined with gamified educational tools. The authors developed a psychiatric adaptation of the « Hat Game ». It was hypothesised that this game would increase both knowledge and motivation in medical students toward psychiatric semiology. The aim of the study was to assess the benefit of a Psychiatric Hat Game session for learning psychiatric symptoms in third-year medical students. Student performance was also evaluated at 3 months. METHODS This gamified fast-track training consists of two teams and each team has to guess as many psychiatric semiology terms as possible using different techniques (i.e. speech, mime). The study involved a pre- and post-evaluation of knowledge (Multiple Choice Questions) and a satisfaction survey. Baseline, post-immediate, and three-months scores were compared by using Friedman analysis for paired samples. Comparisons of mean scores at two different times were performed by using Wilcoxon test for paired samples. RESULTS One hundred and sixty-six students were proposed to take part in the study. Among them 129 completed the whole program (response rate = 77.7%). Mean scores measured at the three points in time were significantly different (p < 0.001, N = 129). Knowledge mean scores were significantly higher after the game than before (+ 28.6%, p < 0.001). Improvement was maintained 3 months after the game (+ 18.9%, p < 0.001). Satisfaction survey items highlighted that students enjoyed and would recommend this type of gamified training. CONCLUSIONS The Psychiatric Hat Game improved knowledge of psychiatric semiology in medical students. Results suggest that it is a promising and efficient tool to playfully teach medical semiology, with transferable features, utility and acceptability from one medical field to another. This study contributes to the growing body of knowledge advocating for serious games and gamified training in medical education.
Collapse
Affiliation(s)
- Anthony Clément
- Neurology Unit, AP-HP, Avicenne University Hospital, Sorbonne Paris Nord, Bobigny, France
- GHU Paris Psychiatrie et Neurosciences, Psychiatry Unit 75G05, Henri Ey Hospital, Paris, France
| | - Raphaël Delage
- Department of Infant, Child and Adolescent Psychiatry, AP-HP, Avicenne University Hospital, Sorbonne Paris Nord, Bobigny, France
| | - Marie Chollier
- Department of Infant, Child and Adolescent Psychiatry, AP-HP, Avicenne University Hospital, Sorbonne Paris Nord, Bobigny, France
- Social and Political Science Department, University of Chester, Chester, UK
| | - Laure Josse
- Healthcare simulation center, UFR SMBH, Sorbonne Paris Nord, Bobigny, France
| | - Stéphane Gaudry
- Service de Réanimation Médico-Chirurgicale, AP-HP, Avicenne University Hospital, Sorbonne Paris Nord, Bobigny, France
| | - Jean-Ralph Zahar
- IAME, UMR 1137, Sorbonne Paris Nord, Paris, France
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention Du Risque Infectieux, AP-HP, Avicenne University Hospital, Sorbonne Paris Nord, Bobigny, France
| | - Thierry Baubet
- GHU Paris Psychiatrie et Neurosciences, Psychiatry Unit 75G05, Henri Ey Hospital, Paris, France
- Université Paris-Saclay, Paris-Sud University, UVSQ, CESP, INSERM, Villejuif, France
| | - Bertrand Degos
- Neurology Unit, AP-HP, Avicenne University Hospital, Sorbonne Paris Nord, Bobigny, France.
- Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France.
| |
Collapse
|
8
|
Dupuy L, Micoulaud-Franchi JA, Cassoudesalle H, Ballot O, Dehail P, Aouizerate B, Cuny E, de Sevin E, Philip P. Evaluation of a virtual agent to train medical students conducting psychiatric interviews for diagnosing major depressive disorders. J Affect Disord 2020; 263:1-8. [PMID: 31818765 DOI: 10.1016/j.jad.2019.11.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/19/2019] [Accepted: 11/28/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND A psychiatric diagnosis involves the physician's ability to create an empathic interaction with the patient in order to accurately extract semiology (i.e., clinical manifestations). Virtual patients (VPs) can be used to train these skills but need to be evaluated in terms of accuracy, and to be perceived positively by users. METHODS We recruited 35 medical students who interacted in a 35-min psychiatric interview with a VP simulating major depressive disorders. Semiology extraction, verbal and non-verbal empathy were measured objectively during the interaction. The students were then debriefed to collect their experience with the VP. RESULTS The VP was able to simulate the conduction of a psychiatric interview realistically, and was effective to discriminate students depending on their psychiatric knowledge. Results suggest that students managed to keep an emotional distance during the interview and show the added value of emotion recognition software to measure empathy in psychiatry training. Students provided positive feedback regarding pedagogic usefulness, realism and enjoyment in the interaction. LIMITATIONS Our sample was relatively small. As a first prototype, the measures taken by the VP would need improvement (subtler empathic questions, levels of difficulty). The face-tracking technique might induce errors in detecting non-verbal empathy. CONCLUSION This study is the first to simulate a realistic psychiatric interview and to measure both skills needed by future psychiatrists: semiology extraction and empathic communication. Results provide evidence that VPs are acceptable by medical students, and highlight their relevance to complement existing training and evaluation tools in the field of affective disorders.
Collapse
Affiliation(s)
- Lucile Dupuy
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France.
| | - Jean-Arthur Micoulaud-Franchi
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France; University Hospital of Bordeaux, CHU Pellegrin - Tripode, Bordeaux Cedex 33076, France
| | - Hélène Cassoudesalle
- University Hospital of Bordeaux, CHU Pellegrin - Tripode, Bordeaux Cedex 33076, France
| | - Orlane Ballot
- University of Laval, Centre d'étude des troubles du sommeil, Québec, G1V 0A6, Canada
| | - Patrick Dehail
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France; University Hospital of Bordeaux, CHU Pellegrin - Tripode, Bordeaux Cedex 33076, France
| | - Bruno Aouizerate
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France; University Hospital of Bordeaux, CHU Pellegrin - Tripode, Bordeaux Cedex 33076, France
| | - Emmanuel Cuny
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France; University Hospital of Bordeaux, CHU Pellegrin - Tripode, Bordeaux Cedex 33076, France
| | - Etienne de Sevin
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France
| | - Pierre Philip
- University of Bordeaux, USR 3413 SANPSY Addiction et Neuropsychiatrie, University of Bordeaux, Site Carreire - Zone Nord, Bat 3B, 3rd floor, Bordeaux Cedex 33076, France; University Hospital of Bordeaux, CHU Pellegrin - Tripode, Bordeaux Cedex 33076, France
| |
Collapse
|