Self-investigation to explore the impact of juvenile arthritis on adolescent life: A case-study

Objective: To gain insight into the personal experience and feelings of an adolescent with a chronic disease. Methods: We report on the application of the self-confrontation method (SCM), illustrated by a case-example of an adolescent with juvenile idiopathic arthritis. Results: Although taken at face value she was not impeded by the arthritis, through self-assessment with the SCM this adolescent acknowledged and addressed the emotional struggle to keep the arthritis secret and to constantly test the physical limits of her body. After the process of self-reflection, the adolescent showed a better integration of her arthritis experiences into her life story. Conclusion: With the SCM the adolescent could explore her own functioning and well-being on a manifest, as well as on an emotional and motivational level. Practice implications: In future research, by studying the self-investigations of a group of adolescents with chronic diseases, common risk factors for the development of a stable identity during adolescence might be identified. In clinical care, the SCM promotes self-knowledge, allowing for an intrinsic motivation to deal with the emotional impact of the disease

The Self beyond Somatic Symptoms : A Narrative Approach to Self-Experience in Adolescent Chronic Fatigue Syndrome

BACKGROUND: The self and self-experience are often assumed to play an important role in adolescent patients presenting with severe somatic symptoms and bodily distress. Nonetheless, most empirical work on this subject is confined to studies of personality and patients' experience of negative emotionality. This study aims to move beyond mere descriptions of symptoms, traits and distress, and consequently adopts a narrative approach to self-experience in adolescent chronic fatigue syndrome (CFS). SAMPLING AND METHODS: The self-confrontation method (SCM) is a well-validated instrument to systematically analyze narrative self-experience. The SCM was used to study 42 adolescents with CFS, compared to 36 adolescents with juvenile idiopathic arthritis (JIA) and 25 matched healthy controls. The Child Health Questionnaire (CHQ-CF87) was used to assess mental health, self-esteem, and physical and psychosocial functioning. RESULTS: Both patient groups reported significantly less positive self-experience of autonomy and success compared to healthy controls. Furthermore, patients with CFS described significantly more negative self-experience of powerlessness, isolation and unfulfilled longing. In the CHQ-CF87, both patient groups scored significantly lower on physical functioning than controls. Adolescents with CFS also scored significantly lower on mental health and self-esteem. CONCLUSIONS: Adolescent CFS entails a serious threat to the self, which might be inherent to the condition. Not only are patients more impaired in mental health, self-esteem, and physical and psychosocial functioning than patients with JIA, they also suffer from a distinct combination of high negative and low positive self-experience. These findings stress the need for strategies that empower patients towards a 'management of the self'

Self-investigation in adolescent chronic fatigue syndrome:Narrative changes and health improvement

Objective: A small-scale intervention study into narrative self-investigation in adolescent chronic fatigue syndrome (CFS). Method: The self-confrontation method (SCM) is an instrument to assess and change personal life stories. Forty-two adolescents diagnosed with CFS were included and randomly assigned to either 6 or 12 sessions with the SCM. Twenty-five healthy adolescents were assigned to 6 sessions. Outcome was measured directly after the self-investigation procedure at 4 months. Follow-up measurements were made 10 months later. The Checklist Individual Strength and the Child Health Questionnaire were used to measure changes in fatigue, physical and psychosocial functioning. Results: Self-investigation resulted in significant changes in participants' narratives. Moreover, after self-investigation there was a significant improvement in fatigue, physical and psychosocial functioning for the adolescents with CFS. The patients who completed 12 sessions improved most. At follow-up, the positive effects were maintained. Conclusion: Self-investigation enables a move beyond the symptoms of CFS in an individualized, patient centered way. Narrative transformation seems to contribute to improved physical and psychosocial outcome in adolescent CFS. Practice implications: The SCM allows adolescents to discover (for themselves) factors that might cause or perpetuate their fatigue. The results suggest that self-investigation is a useful instrument in the management of adolescent CFS

Neutropenic Mice Provide Insight into the Role of Skin-Infiltrating Neutrophils in the Host Protective Immunity against Filarial Infective Larvae

International audienc

Evidence for radial anisotropy in the lower crust of the Apennines from Bayesian ambient noise tomography in Europe

Probing seismic anisotropy of the lithosphere provides valuable clues on the fabric of rocks. We present a 3-D probabilistic model of shear wave velocity and radial anisotropy of the crust and uppermost mantle of Europe, focusing on the mountain belts of the Alps and Apennines. The model is built from Love and Rayleigh dispersion curves in the period range 5–149 s. Data are extracted from seismic ambient noise recorded at 1521 broad-band stations, including the AlpArray network. The dispersion curves are first combined in a linearized least squares inversion to obtain 2-D maps of group velocity at each period. Love and Rayleigh maps are then jointly inverted at depth for shear wave velocity and radial anisotropy using a Bayesian Monte Carlo scheme that accounts for the trade-off between radial anisotropy and horizontal layering. The isotropic part of our model is consistent with previous studies. However, our anisotropy maps differ from previous large scale studies that suggested the presence of significant radial anisotropy everywhere in the European crust and shallow upper mantle. We observe instead that radial anisotropy is mostly localized beneath the Apennines while most of the remaining European crust and shallow upper mantle is isotropic. We attribute this difference to trade-offs between radial anisotropy and thin (hectometric) layering in previous studies based on least-squares inversions and long period data (>30 s). In contrast, our approach involves a massive data set of short period measurements and a Bayesian inversion that accounts for thin layering. The positive radial anisotropy (VSH > VSV) observed in the lower crust of the Apennines cannot result from thin layering. We rather attribute it to ductile horizontal flow in response to the recent and present-day extension in the region

Relocation of earthquakes in the southern and eastern Alps (Austria, Italy) recorded by the dense, temporary SWATH-D network using a Markov chain Monte Carlo inversion

In this study, we analyzed a large seismological dataset from temporary and permanent networks in the southern and eastern Alps to establish high-precision hypocenters and 1-D VP and VP/VS models. The waveform data of a subset of local earthquakes with magnitudes in the range of 1–4.2 ML were recorded by the dense, temporary SWATH-D network and selected stations of the AlpArray network between September 2017 and the end of 2018. The first arrival times of P and S waves of earthquakes are determined by a semi-automatic procedure. We applied a Markov chain Monte Carlo inversion method to simultaneously calculate robust hypocenters, a 1-D velocity model, and station corrections without prior assumptions, such as initial velocity models or earthquake locations. A further advantage of this method is the derivation of the model parameter uncertainties and noise levels of the data. The precision estimates of the localization procedure is checked by inverting a synthetic travel time dataset from a complex 3-D velocity model and by using the real stations and earthquakes geometry. The location accuracy is further investigated by a quarry blast test. The average uncertainties of the locations of the earthquakes are below 500 m in their epicenter and ∼ 1.7 km in depth. The earthquake distribution reveals seismicity in the upper crust (0–20 km), which is characterized by pronounced clusters along the Alpine frontal thrust, e.g., the Friuli-Venetia (FV) region, the Giudicarie–Lessini (GL) and Schio-Vicenza domains, the Austroalpine nappes, and the Inntal area. Some seismicity also occurs along the Periadriatic Fault. The general pattern of seismicity reflects head-on convergence of the Adriatic indenter with the Alpine orogenic crust. The seismicity in the FV and GL regions is deeper than the modeled frontal thrusts, which we interpret as indication for southward propagation of the southern Alpine deformation front (blind thrusts)

Cardiovascular Efficacy and Safety of Bococizumab in High-Risk Patients

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