Le stress post-traumatique chez l'agresseur – intérêt pour le clinicien

Introduction : Cet article présente un cas de psychothérapie de stress post-traumatique chez l’agresseur. Ce syndrome clinique est bien décrit dans la littérature, mais notre recherche ne nous a permis de trouver que 2 rapports de cas témoignant de son traitement en psychothérapie. Le traitement de cette population présente plusieurs défis. Un effort a dû être déployé pour réviser une littérature complexe. D’autres contraintes à notre démarche touchaient l’identification d’un sujet éligible, l’adaptation du protocole de psychothérapie à ce sujet et à au contexte de la pratique clinique, ainsi que l’administration du protocole en tenant compte de contraintes organisationnelles spécifiques. Méthode : Toutes les étapes du projet ont été dirigées par le premier auteur. Une revue de la littérature sur l’état de stress post-traumatique chez l’agresseur a été réalisée sous la supervision du deuxième auteur. Elle a été présentée au congrès annuel de l’Association des Médecins Psychiatres du Québec (AMPQ) de 2011. Cette expérience a permis une sensibilisation aux manifestations de ce syndrome clinique dans la pratique psychiatrique. Grâce à cela, un sujet hospitalisé a été identifié comme présentant des symptômes suggestifs d’état de stress post-traumatique chez l’agresseur. Une psychothérapie a été planifiée et administrée, à partir des connaissances acquises lors de la revue de la littérature, sous la supervision du troisième auteur. Le sujet a été sélectionné par échantillon de convenance. Les données colligées concernant l’évolution clinique du sujet sont de nature qualitative. La méthode d’intervention est une thérapie cognitivo-comportementale intensive, chez un patient hospitalisé. Une attention particulière a été portée au vécu subjectif de l’agresseur, tel que suggéré par la littérature. Un suivi a eu lieu en clinique externe par la suite, permettant de colliger des données supplémentaires. Résultats : L’évolution du sujet a été positive, se concluant par le désir de devenir un membre productif de la société. Conclusion : Un protocole de thérapie cognitivo-comportementale visant l’état de stress post-traumatique en général peut être adapté à la situation de l’agresseur. L’exercice d’être attentif à l’expérience subjective de l’agresseur permet de dépasser certains défis que présente son traitement. La psychothérapie peut être adaptée à la situation du patient hospitalisé en psychiatrie. L’ensemble de la démarche illustrée dans cet article représente un exemple concret d’application de principes scientifiques au traitement d’un sujet dont la présentation clinique ne correspond pas à un diagnostic pour lequel il existe un traitement bien établi. Nous invitons le lecteur clinicien à aborder les défis présentés par un cas clinique en formulant une question de recherche pertinente, qui pourra être mise à l’épreuve pendant la phase de traitement du patient. De plus, nous croyons que la rédaction d’une histoire de cas, organisée en fonction de ce principe, constitue un outil didactique précieux dans la formation en psychiatrie

La santé psychologique et la conciliation travail-famille des infirmières en soins ambulatoires à l’ère de la COVID-19 : résultats d’une enquête

Introduction: The COVID-19 pandemic impacted nurses’ psychological health and work-family balance, including in ambulatory care settings. The results presented in this article are part of a study aiming to describe and contextualize the psychological health and changes in nurses’ follow-up practices in Quebec (Canada) during the COVID-19 pandemic. Objective: Explore and describe factors that influenced ambulatory care nurses’ psychological health and work-family balance during the first wave of the COVID-19 pandemic. Methods: Exploratory mixed data cross-sectional study using the SurveyMonkey platform. We collected data from July 2020 to September 2020. The target population comprised all practicing nurses in Quebec whose clinical activities included the follow-up of ambulatory patients, 200 of whom completed the survey.  Results: Multiple linear regression models indicated that anxiety (GAD-7 scores) and depressive symptoms (PHQ-9 scores) were associated with younger age, living alone, worries about transmitting COVID-19, and feeling that one’s work was not coherent with one’s values. Work-family balance was considered more difficult than before the pandemic by 54.5 % of participants. Factors perceived as influencing work-family balance were either related to work conditions (e.g., schedule and time at work, access to work from home, redeployment to another work setting), to family-related responsibilities/tasks or were specific to the pandemic. Discussion and conclusion: Apart from age, the feeling that one’s work was not coherent with their values was the only variable correlated with both GAD-7 and PHQ-9 in multivariate models. Further research should investigate the relationships between sense of coherence, psychological health, and work conditions like schedule flexibility and access to work from home.Introduction : La pandémie a eu des répercussions sur la santé psychologique et la conciliation travail-famille des infirmières, y compris dans les milieux de soins ambulatoires. Les résultats présentés dans cet article font partie d’une étude visant à décrire et contextualiser la santé psychologique et l’évolution des pratiques de suivi infirmier au Québec (Canada) lors de la pandémie de COVID-19. Objectif : Explorer et décrire les facteurs qui ont influencé la santé psychologique et la conciliation travail-famille des infirmières en soins ambulatoires pendant la première vague de la pandémie de COVID-19. Méthodes : Enquête exploratoire avec données mixtes par le biais de la plateforme SurveyMonkey. Les données ont été collectées de juillet 2020 à septembre 2020. La population cible était toutes les infirmières du Québec dont les activités cliniques incluaient le suivi de patients ambulatoires ; 200 infirmières ont participé. Résultats : Les modèles de régression ont indiqué que les symptômes anxieux (scores au GAD-7) et dépressifs (scores au PHQ-9) étaient associés à un plus jeune âge, au fait de vivre seul, aux inquiétudes concernant la transmission de la COVID-19 et au sentiment que son travail n’était pas cohérent avec ses valeurs. La conciliation travail-famille était jugée plus difficile qu’avant la pandémie par 54,5 % des participants. Les facteurs perçus comme l’influençant étaient soit liés aux conditions de travail (p. ex., horaire et temps de travail, télétravail, délestage), aux tâches familiales, ou étaient spécifiques à la pandémie. Discussion et conclusion : Outre l’âge, le sentiment que son travail n’était pas cohérent avec ses valeurs était la seule variable corrélée à la fois avec le GAD-7 et le PHQ-9. Les futures recherches devraient s’intéresser à la relation entre le sentiment de cohérence, la santé psychologique et les conditions de travail favorables à la conciliation travail-famille

The Influence of Contextual Factors on the Process of Formulating Strategies to Improve the Adoption of Care Manager Activities by Primary Care Nurses

Background: Primary care nurses are well-suited to provide care management for common mental disorders, but their practices depend on context. Various strategies can be considered to improve the adoption of nursing care manager activities, but data from implementation studies rarely address strategy formulation. Aim: To analyze the influence of contextual factors on strategy formulation to improve the adoption of care manager activities by primary care nurses. Method: A qualitative multiple case study in three primary care clinics was carried out. Data were collected through individual interviews (n = 32) and observations (n = 7), working group meetings, and relevant documents. Thematic analysis was conducted. Results: Contextual factors influenced strategy formulation through organizational readiness for change, which resulted from tension for change and perceived organizational ability to implement change. Tension for change was generated through the perceived gap between patient needs and service availability, perceived compatibility with the nurses’ work environment, and their assessment of their capacity to perform care manager activities or acquire the necessary skills. Conclusion: Future studies should give sufficient attention to implementation strategy formulation and consider the dynamic role of organizational readiness for change when facilitating the adoption of evidence-based practices for common mental disorders in primary care

The Psychological Health and Work-Family Balance of Ambulatory Care Nurses in the COVID-19 era: a Cross-Sectional Survey

Introduction: The COVID-19 pandemic impacted nurses’ psychological health and work-family balance, including in ambulatory care settings. The results presented in this article are part of a study aiming to describe and contextualize the psychological health and changes in nurses’ follow-up practices in Quebec (Canada) during the COVID-19 pandemic. Objective: Explore and describe factors that influenced ambulatory care nurses’ psychological health and work-family balance during the first wave of the COVID-19 pandemic. Methods: Exploratory mixed data cross-sectional study using the SurveyMonkey platform. We collected data from July 2020 to September 2020. The target population comprised all practicing nurses in Quebec whose clinical activities included the follow-up of ambulatory patients, 200 of whom completed the survey.  Results: Multiple linear regression models indicated that anxiety (GAD-7 scores) and depressive symptoms (PHQ-9 scores) were associated with younger age, living alone, worries about transmitting COVID-19, and feeling that one’s work was not coherent with one’s values. Work-family balance was considered more difficult than before the pandemic by 54.5 % of participants. Factors perceived as influencing work-family balance were either related to work conditions (e.g., schedule and time at work, access to work from home, redeployment to another work setting), to family-related responsibilities/tasks or were specific to the pandemic. Discussion and conclusion: Apart from age, the feeling that one’s work was not coherent with their values was the only variable correlated with both GAD-7 and PHQ-9 in multivariate models. Further research should investigate the relationships between sense of coherence, psychological health, and work conditions like schedule flexibility and access to work from home

Love and affectionate touch toward romantic partners all over the world

Touch is the primary way people communicate intimacy in romantic relationships, and affectionate touch behaviors such as stroking, hugging and kissing are universally observed in partnerships all over the world. Here, we explored the association of love and affectionate touch behaviors in romantic partnerships in two studies comprising 7880 participants. In the first study, we used a cross-cultural survey conducted in 37 countries to test whether love was universally associated with affectionate touch behaviors. In the second study, using a more fine-tuned touch behavior scale, we tested whether the frequency of affectionate touch behaviors was related to love in romantic partnerships. As hypothesized, love was significantly and positively associated with affectionate touch behaviors in both studies and this result was replicated regardless of the inclusion of potentially relevant factors as controls. Altogether, our data strongly suggest that affectionate touch is a relatively stable characteristic of human romantic relationships that is robustly and reliably related to the degree of reported love between partners.info:eu-repo/semantics/publishedVersio

La sculpture romaine en Occident

Cet ouvrage réunit les résultats de deux manifestations complémentaires  : d’une part, la table ronde intitulée «  Rendre à César  », organisée le mercredi 20 juin 2012, à Paris, au Musée du Louvre et, d’autre part, les «  Rencontres autour de la sculpture romaine conservée en France  » qui ont eu lieu du 18 au 20 octobre 2012 au Musée départemental Arles antique. La richesse des interventions lors de ces deux manifestations permet de restituer un ouvrage composé de trente-huit articles, répartis en trois parties et une conclusion. La première partie, en écho et en développement de la table ronde du Louvre, porte sur le portrait du «  César du Rhône  », aussi bien que sur «  Le portrait romain en Gaule  ». La deuxième partie publie cinq études autour des «  nouvelles techniques d’investigations scientifiques  » et présente l’analyse des matériaux des sculptures en pierre et en bronze, découvertes dans le Rhône à Arles, ainsi qu’une étude ethnoarchéologique sur les techniques de production du portrait. Enfin une troisième partie présente les «  découvertes récentes et les nouvelles recherches  », déclinées en seize études qui sont consacrées à des études de cas (Autun, Vaison-la-Romaine, Nîmes, Metz-Divodurum, Apt), ainsi qu’à des relectures novatrices de sculptures méconnues (Plouarzel, Langres, Avignonet-Lauragais, Vernègues, vallée de l’Ubaye, Besançon, Lyon). Robert Turcan signe la conclusion. Ainsi, «  La sculpture romaine en Occident. Nouveaux regards   » reflète la variété et l’intérêt des questionnements actuels dans ce domaine

State of the climate in 2018

In 2018, the dominant greenhouse gases released into Earth’s atmosphere—carbon dioxide, methane, and nitrous oxide—continued their increase. The annual global average carbon dioxide concentration at Earth’s surface was 407.4 ± 0.1 ppm, the highest in the modern instrumental record and in ice core records dating back 800 000 years. Combined, greenhouse gases and several halogenated gases contribute just over 3 W m−2 to radiative forcing and represent a nearly 43% increase since 1990. Carbon dioxide is responsible for about 65% of this radiative forcing. With a weak La Niña in early 2018 transitioning to a weak El Niño by the year’s end, the global surface (land and ocean) temperature was the fourth highest on record, with only 2015 through 2017 being warmer. Several European countries reported record high annual temperatures. There were also more high, and fewer low, temperature extremes than in nearly all of the 68-year extremes record. Madagascar recorded a record daily temperature of 40.5°C in Morondava in March, while South Korea set its record high of 41.0°C in August in Hongcheon. Nawabshah, Pakistan, recorded its highest temperature of 50.2°C, which may be a new daily world record for April. Globally, the annual lower troposphere temperature was third to seventh highest, depending on the dataset analyzed. The lower stratospheric temperature was approximately fifth lowest. The 2018 Arctic land surface temperature was 1.2°C above the 1981–2010 average, tying for third highest in the 118-year record, following 2016 and 2017. June’s Arctic snow cover extent was almost half of what it was 35 years ago. Across Greenland, however, regional summer temperatures were generally below or near average. Additionally, a satellite survey of 47 glaciers in Greenland indicated a net increase in area for the first time since records began in 1999. Increasing permafrost temperatures were reported at most observation sites in the Arctic, with the overall increase of 0.1°–0.2°C between 2017 and 2018 being comparable to the highest rate of warming ever observed in the region. On 17 March, Arctic sea ice extent marked the second smallest annual maximum in the 38-year record, larger than only 2017. The minimum extent in 2018 was reached on 19 September and again on 23 September, tying 2008 and 2010 for the sixth lowest extent on record. The 23 September date tied 1997 as the latest sea ice minimum date on record. First-year ice now dominates the ice cover, comprising 77% of the March 2018 ice pack compared to 55% during the 1980s. Because thinner, younger ice is more vulnerable to melting out in summer, this shift in sea ice age has contributed to the decreasing trend in minimum ice extent. Regionally, Bering Sea ice extent was at record lows for almost the entire 2017/18 ice season. For the Antarctic continent as a whole, 2018 was warmer than average. On the highest points of the Antarctic Plateau, the automatic weather station Relay (74°S) broke or tied six monthly temperature records throughout the year, with August breaking its record by nearly 8°C. However, cool conditions in the western Bellingshausen Sea and Amundsen Sea sector contributed to a low melt season overall for 2017/18. High SSTs contributed to low summer sea ice extent in the Ross and Weddell Seas in 2018, underpinning the second lowest Antarctic summer minimum sea ice extent on record. Despite conducive conditions for its formation, the ozone hole at its maximum extent in September was near the 2000–18 mean, likely due to an ongoing slow decline in stratospheric chlorine monoxide concentration. Across the oceans, globally averaged SST decreased slightly since the record El Niño year of 2016 but was still far above the climatological mean. On average, SST is increasing at a rate of 0.10° ± 0.01°C decade−1 since 1950. The warming appeared largest in the tropical Indian Ocean and smallest in the North Pacific. The deeper ocean continues to warm year after year. For the seventh consecutive year, global annual mean sea level became the highest in the 26-year record, rising to 81 mm above the 1993 average. As anticipated in a warming climate, the hydrological cycle over the ocean is accelerating: dry regions are becoming drier and wet regions rainier. Closer to the equator, 95 named tropical storms were observed during 2018, well above the 1981–2010 average of 82. Eleven tropical cyclones reached Saffir–Simpson scale Category 5 intensity. North Atlantic Major Hurricane Michael’s landfall intensity of 140 kt was the fourth strongest for any continental U.S. hurricane landfall in the 168-year record. Michael caused more than 30 fatalities and $25 billion (U.S. dollars) in damages. In the western North Pacific, Super Typhoon Mangkhut led to 160 fatalities and$6 billion (U.S. dollars) in damages across the Philippines, Hong Kong, Macau, mainland China, Guam, and the Northern Mariana Islands. Tropical Storm Son-Tinh was responsible for 170 fatalities in Vietnam and Laos. Nearly all the islands of Micronesia experienced at least moderate impacts from various tropical cyclones. Across land, many areas around the globe received copious precipitation, notable at different time scales. Rodrigues and Réunion Island near southern Africa each reported their third wettest year on record. In Hawaii, 1262 mm precipitation at Waipā Gardens (Kauai) on 14–15 April set a new U.S. record for 24-h precipitation. In Brazil, the city of Belo Horizonte received nearly 75 mm of rain in just 20 minutes, nearly half its monthly average. Globally, fire activity during 2018 was the lowest since the start of the record in 1997, with a combined burned area of about 500 million hectares. This reinforced the long-term downward trend in fire emissions driven by changes in land use in frequently burning savannas. However, wildfires burned 3.5 million hectares across the United States, well above the 2000–10 average of 2.7 million hectares. Combined, U.S. wildfire damages for the 2017 and 2018 wildfire seasons exceeded $40 billion (U.S. dollars)