Improving empathy in the care of pain patients

Empathy is associated with countless benefits in clinical interactions, yet it is not always optimal in health care providers. Social neuroscience offers a window onto the cerebral processes underlying the complex relationships between the multiple components of empathy, patient care, and the caregiver’s well-being. Neuroimaging studies have revealed patterns of empathyrelated neural responses that shed some light on the mechanisms that could partially explain the phenomena of empathy decline and pain underestimation in health care providers. Such information, complementary to behavioral research findings, may help develop new means of improving empathy in health care, as long as interpretation of neuroimaging data remains grounded. Additionally, research on empathy in this context has largely focused on how clinicians’ empathy may affect patient outcomes, but the relationship between empathy and well-being in health care providers is often neglected. The quest to optimize empathy in patient–clinician interactions must take into account the welfare of both members of this dyad

The perception and estimation of others’ pain according to children

Accurate interpretation of pain expressed by others is important for socialization; however, the development of this skill in children is still poorly understood. Empathy for pain models propose two main components (affective and cognitive), which develop at different stages of life. The study’s objective was to investigate the children’s ability between 3 and 12 years of age to detect and assess the pain intensity in others using visual stimuli depicting either facial expressions of pain or hands in painful contexts. 40 preschool children and 62 school-aged children were recruited. Children observed series of stimuli and evaluated the pain intensity depicted. Results demonstrated that children as young as three years old were able to detect and assess pain in both types of stimuli and this ability continued to improve until the age of 12. Participants demonstrated better detection performance with hands than with faces. Results were coherent with the idea that the two types of stimuli presented recruit different processes. Pain detection in hands appears to rely mostly on affective sharing processes that are effective early in life, while older children’s higher ability to perceive pain in facial expressions suggests that this ability is associated with the gradual development of cognitive processes

LES URGENCES OBSTÉTRICALES À L’HÔPITAL UNIVERSITAIRE DE PARAKOU AU BÉNIN : ASPECTS CLINIQUES, THÉRAPEUTIQUES ET ÉVOLUTIFS

Objective: To describe the clinical, therapeutic and outcome aspects of emergency obstetric care at the University Hospital of Parakou in Benin. Patients and methods: This was a descriptive and analytical cross-sectional study with prospective data collection. It covered a period of 6 months (14 January to 14 July 2013) and involved 507 patients. Results: The intake frequency of obstetrics emergencies was 31.8%. The mean age of patients was 26.7 ± 6.2 years, ranging from 15 to 45 years. The admission average time was 32 ± 27.8 hours. The mean gravidity was 3.21 ± 2.16 and the mean parity was 2.00 ± 2.13. The major identified emergency obstetrics groups were: dystocia (32.1%), hemorrhagic emergencies (21.7%), hypertensive emergencies (16.4%), fetal hypoxia (15.2%), the infectious emergencies (12.4%) and anemia on pregnancy (2.2%). The average hospital stay was 4.0 ± 3.4 days with a range of 1 to 23 days. Maternal mortality was 0.4%. Fetal mortality was 9.2% and was related to the occurrence of antepartum hemorrhage (p = 0.001), poor monitoring of antenatal care (p = 0.001) in obstructed labor (p = 0.001), and the presence meconium in the amniotic fluid (p = 0.001). Conclusion: Obstetrics emergencies are common in the maternity of the University Hospital of Parakou. Reducing the morbidity and mortality associated with obstetric emergencies happen by improving the quality of care for the education of patients to consult early to improving the technical platform and the introduction of insurance universal health

LES URGENCES OBSTÉTRICALES À L’HÔPITAL UNIVERSITAIRE DE PARAKOU AU BÉNIN : ASPECTS CLINIQUES, THÉRAPEUTIQUES ET ÉVOLUTIFS

Objective: To describe the clinical, therapeutic and outcome aspects of emergency obstetric care at the University Hospital of Parakou in Benin. Patients and methods: This was a descriptive and analytical cross-sectional study with prospective data collection. It covered a period of 6 months (14 January to 14 July 2013) and involved 507 patients. Results: The intake frequency of obstetrics emergencies was 31.8%. The mean age of patients was 26.7 ± 6.2 years, ranging from 15 to 45 years. The admission average time was 32 ± 27.8 hours. The mean gravidity was 3.21 ± 2.16 and the mean parity was 2.00 ± 2.13. The major identified emergency obstetrics groups were: dystocia (32.1%), hemorrhagic emergencies (21.7%), hypertensive emergencies (16.4%), fetal hypoxia (15.2%), the infectious emergencies (12.4%) and anemia on pregnancy (2.2%). The average hospital stay was 4.0 ± 3.4 days with a range of 1 to 23 days. Maternal mortality was 0.4%. Fetal mortality was 9.2% and was related to the occurrence of antepartum hemorrhage (p = 0.001), poor monitoring of antenatal care (p = 0.001) in obstructed labor (p = 0.001), and the presence meconium in the amniotic fluid (p = 0.001). Conclusion: Obstetrics emergencies are common in the maternity of the University Hospital of Parakou. Reducing the morbidity and mortality associated with obstetric emergencies happen by improving the quality of care for the education of patients to consult early to improving the technical platform and the introduction of insurance universal health

Modulation of Brain Activity during Action Observation: Influence of Perspective, Transitivity and Meaningfulness

The coupling process between observed and performed actions is thought to be performed by a fronto-parietal perception-action system including regions of the inferior frontal gyrus and the inferior parietal lobule. When investigating the influence of the movements' characteristics on this process, most research on action observation has focused on only one particular variable even though the type of movements we observe can vary on several levels. By manipulating the visual perspective, transitivity and meaningfulness of observed movements in a functional magnetic resonance imaging study we aimed at investigating how the type of movements and the visual perspective can modulate brain activity during action observation in healthy individuals. Importantly, we used an active observation task where participants had to subsequently execute or imagine the observed movements. Our results show that the fronto-parietal regions of the perception action system were mostly recruited during the observation of meaningless actions while visual perspective had little influence on the activity within the perception-action system. Simultaneous investigation of several sources of modulation during active action observation is probably an approach that could lead to a greater ecological comprehension of this important sensorimotor process

A developmental perspective on the neural bases of human empathy

While empathy has been widely studied in philosophical and psychological literatures, recent advances in social neuroscience have shed light on the neural correlates of this complex interpersonal phenomenon. In this review, we provide an overview of brain imaging studies that have investigated the neural substrates of human empathy. Based on existing models of the functional architecture of empathy, we review evidence of the neural underpinnings of each main component, as well as their development from infancy. Although early precursors of affective sharing and self-other distinction appear to be present from birth, recent findings also suggest that even higher-order components of empathy such as perspective-taking and emotion regulation demonstrate signs of development during infancy. This merging of developmental and social neuroscience literature thus supports the view that ontogenic development of empathy is rooted in early infancy, well before the emergence of verbal abilities. With age, the refinement of top-down mechanisms may foster more appropriate empathic responses, thus promoting greater altruistic motivation and prosocial behaviors

Viroinval/Olloy-sur-Viroin et Dourbes :la fortification protohistorique du "Plateau des Cinques", campagne 2014

info:eu-repo/semantics/publishe

Difference in neural response to social exclusion observation and subsequent altruism between adolescents and adults

Empathy and prosocial behaviors toward peers promote successful social development and creation of significant long-term relationships, but surprisingly little is known about the maturation of these skills during the period of adolescence. As the majority of studies have used questionnaires or pain observation paradigms, it remains unknown whether the empathic response of adolescents differs from that of adults in a paradigm that is closer to everyday life. In the current study, fMRI was used to examine the neural correlates of social exclusion observation and subsequent prosocial behavior in 20 adolescents (aged 12–17 years) and 20 adults (aged 22–30 years) while playing a ball-tossing game with what they believed to be real individuals. Observing someone being excluded compared to observing equal inclusion of all players elicited a significantly higher activation of the IFG (pars triangularis) in adults compared to adolescents. When given the opportunity to directly help the excluded player during the game, adolescents showed significantly less prosocial behavior than adults, which was underpinned by a significantly lower activity in the right temporoparietal junction, medial/dorsomedial prefrontal cortex and fusiform face area. These findings might indicate that adolescents have a lower propensity to take the victim's perspective and share his or her distress when witnessing social exclusion, which leads to a lower altruistic motivation to help. The factors that could generate what can be interpreted as a downward modulation of empathy during adolescence are discussed

Neural correlates of prosocial behaviour towards persons in pain in healthcare providers

Pain perceived in others can be a stressful signal that elicits personal distress and discomfort that can interfere with prosocial behaviors. Healthcare providers (HCPs) have to be able to regulate these self-oriented feelings to offer optimal help to patients in pain. However, previous studies have documented a tendency in HCPs to underestimate the pain of patients that could interfere with optimal help to these patients. The aim of this study was to compare HCP and control (CTL) participants’ prosocial behavior towards persons in pain and their associated brain responses. HCPs and CTL participants took part in a newly developed prosocial task during which they were asked to choose how much time they wanted to offer to help patients in pain. It was shown that compared to CTL participants, HCPs offered more help to persons in pain and reported less trait personal distress when facing suffering in others. Additional evidence was provided by the fMRI results, which indicated that compared to CTL participants, HCP participants showed different pattern of activity in the dorsolateral prefrontal cortex, bilateral precuneus and the posterior cingulate cortex during the prosocial task, suggesting that the underlying mechanisms of the difference in prosocial behaviors could vary according to the degree to which processes such as mentalizing and cognitive control are solicited

A review of the factors modulating the cerebral and behavioral responses to others’ pain

La douleur est une expérience subjective propre à chaque individu qui l’expérimente. Un observateur ne peut donc qu’inférer la douleur de la personne souffrante puisqu’il ne peut pas la mesurer directement. Une évaluation adéquate de la douleur dans un contexte de soins, notamment par les professionnels de la santé ou par les aidants naturels, est essentielle à une prise en charge appropriée de celle-ci. Cet article présente différents facteurs qui peuvent influencer les réponses comportementale et cérébrale face à la douleur d’autrui. Ces facteurs seront présentés en trois catégories, soient ceux liés à l’observateur, ceux liés à la personne en douleur et ceux liés au contexte ou à la relation entre l’observateur et la personne en douleur. L’impact de ces facteurs en contexte d’intervention et de traitement de la douleur est discuté. Nous proposons que la perception optimale de la douleur d’autrui ou du moins la connaissance des différents facteurs pouvant moduler l’évaluation de cette douleur, représente une première étape vers une meilleure prise en charge de la douleur par les intervenants concernés.Pain is a subjective experience that is directly accessible only to the person experiencing it. The private nature of pain means that observers can only infer the level of pain in others. An accurate evaluation of pain in a clinical context (p. ex., by health care professionals or informal caregivers) is essential to optimize pain management. Here, we present factors that can influence the behavioral and cerebral responses to the pain of others. These factors are divided into three categories: factors related to the observer, factors related to the person in pain, and contextual and relational factors. We discuss the impact of these factors within the clinical context of pain management. We propose that for professional and informal caregivers, accurately evaluating pain in others, or at least being aware of the factors that can affect this evaluation, is a first step toward providing optimal care to patients