A Cognitive and Virtual Reality Treatment Program for the Fear of Flying

International audienceBACKGROUND: Passenger air transport has considerably increased in the past 50 yr. It is estimated that between 7 and 40% of the population of industrialized countries is currently afraid of flying. Programs treating the fear of flying have been developed to meet this problem. This study measures the effectiveness of one of these programs by focusing on flight-related anxiety before the program and after the first flight following the intervention.METHODS: There were 157 individuals recruited to participate in a 1-d intervention aiming at treating the fear of flying, and using both cognitive behavioral techniques and virtual reality. Anxiety was measured with the Flight Anxiety Situations (FAS) and the Flight Anxiety Modality (FAM) questionnaires.RESULTS: Statistical analyses were conducted on 145 subjects (69.7% female; ages from 14 to 64) after the exclusion of individuals with missing data. The results showed a decrease in flight-related anxiety for each subscale of the two questionnaires: the somatic (d = 2.44) and cognitive anxiety (d = 1.47) subscales of the FAM, and the general flight anxiety (d = 3.20), the anticipatory flight anxiety (d = 1.74), and the in-flight anxiety (d = 1.04) subscales of the FAS.CONCLUSIONS: The effectiveness of the treatment program using both cognitive behavioral techniques and virtual reality strategies for fear of flying reduced flight-related anxiety in the subjects in our study. Our results show that subjects demonstrated lower anxiety levels after the first flight following the program than before the intervention

Le deuil des conjoints après un cancer (entre évaluation et expérience subjective)

En 2011, en France, plus de 147 525 hommes et femmes sont morts d un cancer. Cette pathologie ne touche pas seulement les personnes les plus âgées : 41 000 décès prématurés, survenant avant 65 ans sont dus au cancer (FRANCIM, InVS, CIRC). Ce sont autant de personnes qui vivaient potentiellement en couple. En cas de décès, des bouleversements plus ou moins pérennes vont toucher le conjoint, sur un plan psychique, physique et social. Les proches du patient cancéreux constituent l une de ses premières sources de soutien tout au long de sa maladie. Différentes recherches menées ces dernières années ont souligné la vulnérabilité psychique de ces aidants-soignants , notamment en termes de symptômes anxio-dépressifs. Les facteurs de risque sociodémographiques identifiés (comme le fait d être une femme, d être plus âgé, et l existence de deuils antérieurs) ne prennent pas en compte le fonctionnement psychique et affectif des conjoints : les relations de l aidant au malade, sa personnalité, ni même son vécu subjectif de la maladie et de la fin de vie. Lorsque l issue du cancer est fatale, il semble que parmi les proches, ce soient les conjoints des patients qui rencontrent le plus de difficultés pour faire face au décès : le risque de deuil compliqué (Prolonged Grief Disorder, Prigerson et al, 2009) serait plus important dans cette population. A l heure actuelle, l existence de cette catégorie nosographique fait encore débat et les données empiriques longitudinales font défaut pour spécifier le caractère pathologique du deuil dans le champ du cancer. Les propositions de soutien psychologique pour ces personnes si intensément sollicitées restent finalement méconnues, à la fois par les conjoints endeuillés, qui y ont rarement recours, et par certains professionnels du soin. ObjectifsCette recherche a pour objectif d identifier et de comprendre les déterminants des processus de deuil chez les conjoints, amorcés dès la fin de vie de la personne atteinte de cancer en phase palliative, et déployés à moyen et long terme. Cette étude vise également à décrire la phénoménologie normale du deuil, ainsi que ses manifestations pathologiques. La proposition d outils de réflexion favorisant la mise en place de dispositifs de soutien adaptés aux conjoints endeuillés, constitue le dernier objectif de cette recherche.MéthodesDeux études ont été réalisées. L étude 1, quantitative, utilise une batterie psychométrique évaluant la détresse émotionnelle, l ajustement social, le développement post-traumatique, les styles d attachement et de coping, et enfin la personnalité des conjoints. Cette étude propose un suivi de cohorte durant la phase palliative (N=60)/6 mois après le décès (N=36) où l on met en relation des données personnelles initiales avec l ajustement ultérieur des conjoints de patients. L étude 2, qualitative, propose une exploration de l expérience personnelle de dix conjoints confrontés à la perte et de leurs processus de mise en sens à l aide de l Interpretative Phénoménological Analysis (IPA, Smith, Flowers, & Larkin, 2009). Résultats Les analyses quantitatives ont montré que la grande majorité des conjoints présentaient pendant la phase palliative une symptomatologie dépressive et souffraient d un fardeau lié à la prise en charge du malade, tandis que leur adaptation sociale semble globalement préservée. Après la mort du patient, l intensité des symptômes dépressifs augmente pour la majorité des conjoints endeuillés (53%), tandis qu une minorité (13%) souffre d un trouble du deuil prolongé. La détresse des conjoints endeuillés est avant tout prédite par leur niveau de dépression mesurée avant le décès, et peu par les variables liées à la maladie ou au décès lui-même. Les styles d attachement permettent d autre part d identifier des profils adaptatifs chez les conjoints....In 2011, in France, more than 147 525 men and women died through cancer. This disease doesn t affect only the oldest: 41 000 untimely deaths, before 65 years, are caused by cancer (FRANCIM, InVS, CIRC). All these persons were supposed to live with a partner. Faced with the patient s death, more or less sustainable psychological, physical or social upheavals will affect the spouse.The cancer patient s relatives and family constitute one of the patient s main sources of support throughout the disease, but this support is not always recognized by physicians. Over recent years, several studies have emphasized the psychological vulnerability of these caregivers especially in terms of anxiety and depression patterns. However, identified sociodemographic risk factors (e.g. being a woman, being older, and having experienced previous grief) do not take into account the socio-affective and cognitive functioning of the patient s spouse. The relationship with the patient, the caregiver s personality, or the subjective experience of illness and end of life are considered to be critical by clinicians, but are largely ignored in empirical research. When the outcome of cancer is fatal, among the patient s family and friends, the spouse appears to encounter the greatest difficulties to cope with her/his grief: the risk of complicated grief is more considerable among this population. Currently, the existence of this disorder (Prolonged Grief Disorder, Prigerson et al, 2009) still remains in debate and the lack of empirical longitudinal data to specify the pathological aspect of grief in the field of cancer, hinders any scientific consensus.Psychological support provided to these intensely requested persons remains poorly known, both by bereaved spouses, who have rarely resort to support facility, and by some healthcare professionals. AimsThis study aims at identifying and understanding the predictors of grief among bereaved spouses of cancer patients, induced from end of life to the mid- and long- term grief period. We also want to describe the normal phenomenology of grief, and its complicated manifestations. Finally this research aims at providing reflection tools facilitating the implementation of adapted support programs for bereaved spouses.MethodsTwo complementary studies were conducted. Study 1, a quantitative study, uses a psychometric battery assessing the distress, the social adjustment, the post-trauamtic growth, the styles of attachment and of coping, as well as the personality in spouses of cancer patients. This study consists of following-up of a cohort during the palliative period (N=60)/6 months after death (N=36), to capture correlations between initial personal data and subsequent adjustment. Study 2 is a qualitative study, which provides an investigation of ten spouses experience facing the loss of their loved one. This experience and their making sense processes were studied with the Interpretative Phénoménological Analysis (IPA, Smith, Flowers & Larkin, 2009)ResultsThe quantitative analyses showed that the vast majority of the spouses reported during the palliative phase a depressive symptomatology and feelings of burden associated with the caregiving of the patient. Their social adaptation is globally preserved. After the death of the patient, the intensity of the depressive symptoms increase for the majority of the bereaved spouses (53%), while a minority (13%) meet the criteria for a Prolonged Grief Disorder. Above all, the distress of the latter is predicted by their levels of depression assessed before the death. The factors linked to the disease or to the death itself hardly constitute good predictors of the condition of the bereaved spouses. The attachment styles allow us to identify adaptative profiles in this population.....PARIS5-Bibliotheque electronique (751069902) / SudocSudocFranceF

Influenza Epidemics in the United States, France, and Australia, 1972–19971

Influenza epidemics occur once a year during the winter in temperate areas. Little is known about the similarities between epidemics at different locations. We have analyzed pneumonia and influenza deaths from 1972 to 1997 in the United States, France, and Australia to examine the correlation over space and time between the three countries. We found a high correlation in both areas between France and the United States (correlation in impact, Spearman’s ρ = 0.76, p < 0.001, and test for synchrony in timing of epidemics, p < 0.001). We did not find a similar correlation between the United States and Australia or between France and Australia, when considering a systematic half-year lead or delay of influenza epidemics in Australia as compared with those in the United States or France. These results support a high correlation at the hemisphere level and suggest that the global interhemispheric circulation of epidemics follows an irregular pathway with recurrent changes in the leading hemisphere

Patients' perceptions of the mechanisms underlying alcohol use problems after bariatric surgery: A qualitative systematic review.

peer reviewedAlcohol-related problems increase after bariatric surgery. The objective of this review was to synthesize findings of qualitative studies on patients' perceptions of the mechanisms leading to problematic alcohol consumption after bariatric surgery. This review followed the Joanna Briggs Institute methodology for systematic review of qualitative evidence. A comprehensive search strategy was performed in MEDLINE, PsycInfo, Scopus and Google Scholar. Study selection, data extraction and critical appraisal of included studies were undertaken by two independent reviewers. Confidence in review findings was assessed using the ConQual approach. Four studies were included in this review and led to the development of four synthesized results: (1) persistence or reappearance of psychological problems after bariatric surgery; (2) using alcohol as a coping strategy, sometimes as a replacement for food; (3) changes in the physiological response to alcohol; and (4) importance of increased information about alcohol-related risks and long-term counselling. Confidence in the synthesized results ranged from moderate to low. The results indicated postoperative problematic alcohol consumption is a complex issue, involving psychological and physiological mechanisms. Several recommendations are formulated based on the results obtained. More qualitative and quantitative studies are needed to better understand this phenomenon given the few existing qualitative studies on this topic and some divergent results found between qualitative and previous quantitative research

Les signes en société

Stéphane Breton, maître de conférences Anthropologie du regard : le cinéma documentaire et l’expérience ethnographique (2) Le propre de la prise de vues, qu’elle soit photographique ou cinématographique – ce qui revient au même du point de vue technique –, est qu’elle enregistre l’instant exact de son opération. À cet égard, parmi tous les arts, elle est unique. Son image ne relève pas du registre de la représentation, ni même seulement de la reproduction, mais de l’enregistrement, dans leque..

Les signes en société

Stéphane Breton, maître de conférences Anthropologie du regard : le cinéma documentaire et l’expérience ethnographique (2) Le propre de la prise de vues, qu’elle soit photographique ou cinématographique – ce qui revient au même du point de vue technique –, est qu’elle enregistre l’instant exact de son opération. À cet égard, parmi tous les arts, elle est unique. Son image ne relève pas du registre de la représentation, ni même seulement de la reproduction, mais de l’enregistrement, dans leque..

Towards a characterization of behavior-disease models

The last decade saw the advent of increasingly realistic epidemic models that leverage on the availability of highly detailed census and human mobility data. Data-driven models aim at a granularity down to the level of households or single individuals. However, relatively little systematic work has been done to provide coupled behavior-disease models able to close the feedback loop between behavioral changes triggered in the population by an individual's perception of the disease spread and the actual disease spread itself. While models lacking this coupling can be extremely successful in mild epidemics, they obviously will be of limited use in situations where social disruption or behavioral alterations are induced in the population by knowledge of the disease. Here we propose a characterization of a set of prototypical mechanisms for self-initiated social distancing induced by local and non-local prevalence-based information available to individuals in the population. We characterize the effects of these mechanisms in the framework of a compartmental scheme that enlarges the basic SIR model by considering separate behavioral classes within the population. The transition of individuals in/out of behavioral classes is coupled with the spreading of the disease and provides a rich phase space with multiple epidemic peaks and tipping points. The class of models presented here can be used in the case of data-driven computational approaches to analyze scenarios of social adaptation and behavioral change.Comment: 24 pages, 15 figure

Prédictions épidémiologiques de la grippe en zones tempérées

PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF