Thérapie cognitive-comportementale pour l'état de stress post-traumatique administrée en vidéoconférence : efficacité et impact sur l'alliance thérapeutique

Plusieurs victimes d'événements traumatiques sont à risque de développer un état de stress post-traumatique (ÉSPT). Certaines formes d'interventions psychologiques comme la thérapie cognitive-comportementale (TCC) ont démontré leur efficacité à traiter l'ÉSPT. Toutefois, les ressources valables pouvant aider les victimes à cheminer vers la guérison demeurent parfois inaccessibles car la plupart des cliniciens possédant une expertise dans l'application de la TCC se trouvent dans les régions urbaines ou dans les centres spécialisés. Les individus vivant loin de ces services et dont la condition physique ou psychologique complique les déplacements requis sont souvent privés de soutien professionnel adéquat. Dans ce contexte, il apparaît souhaitable et nécessaire de rendre ce type d'intervention accessible à tous afin d'alléger les souffrances des victimes de traumatismes et d'améliorer leur niveau de fonctionnement. Une solution envisageable et prometteuse consiste à administrer des services psychologiques à distance par l'entremise de moyens technologiques tels que la vidéoconférence. La présente étude vise à évaluer l'efficacité d'une TCC offerte en vidéoconférence auprès d'individus souffrant d'un ÉSPT. Quarante-huit personnes participent au projet et reçoivent une TCC administrée soit en vidéoconférence, soit de manière conventionnelle en face à face. Le chapitre I du présent document expose le contexte général de cette thèse en situant notamment l'état des écrits effectués à ce jour sur la télépsychothérapie. Le chapitre Il, pour sa part, expose les principaux résultats comparatifs obtenus sur l'efficacité de la thérapie offerte en vidéoconférence et en face à face. Dans l'ensemble, les données permettent de constater une amélioration significative de la symptomatologie et du fonctionnement global des victimes suite aux traitements proposés. Aucune différence significative entre les deux modalités thérapeutiques n'est observée. Par la suite, considérant l'importance d'établir une relation thérapeutique de qualité auprès de cette population fragilisée, le chapitre III examine l'impact de l'utilisation de la vidéoconférence sur l'alliance thérapeutique. Les résultaIs démontrent que l'alliance n'est pas compromise par la distance et l'emploi d'un tel outil technologique. Finalement, le chapitre IV constitue une discussion générale des résultats obtenus. Différentes considérations méthodologiques, cliniques et pratiques y sont aussi exposées. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Télépsychothérapie, État de stress post-traumatique, Thérapie Cognitive-Comportementale, Efficacité, Alliance thérapeutique

Relative efficacy of cognitive-behavioral therapy administered by videoconference for posttraumatic stress disorder : a six-month follow-up

Until recently, only one study was published on cognitive-behavioral therapy (CBT) of posttraumatic stress disorder (PTSD) in individual therapy via videoconference (Germain, Marchand, Bouchard, Drouin, & Guay, 2009); however, it only assessed the posttreatment effect. This study presents the follow-up of Germain et al.’s (2009) study. The main goal was to compare the effectiveness after six months of CBT for PTSD either face-to-face (n = 24) or by videoconference (n = 12). Each participant received CBT for 16 to 25 weeks and completed various questionnaires before and after treatment and at a six-month follow-up. The two treatments had equivalent levels of symptom reduction (Modified PTSD Symptom Scale: η2 .05) and proportion of patients with a clinically significant change in symptoms (42% for face-to-face vs. 38% for videoconferencing, p > .05). Thus, CBT for PTSD via videoconference seems to be a viable alternative when adequate face-to-face treatments are less available

TRIM33 switches off Ifnb1 gene transcription during the late phase of macrophage activation

Despite its importance during viral or bacterial infections, transcriptional regulation of the interferon-β gene (Ifnb1) in activated macrophages is only partially understood. Here we report that TRIM33 deficiency results in high, sustained expression of Ifnb1 at late stages of toll-like receptor-mediated activation in macrophages but not in fibroblasts. In macrophages, TRIM33 is recruited by PU.1 to a conserved region, the Ifnb1 Control Element (ICE), located 15 kb upstream of the Ifnb1 transcription start site. ICE constitutively interacts with Ifnb1 through a TRIM33-independent chromatin loop. At late phases of lipopolysaccharide activation of macrophages, TRIM33 is bound to ICE, regulates Ifnb1 enhanceosome loading, controls Ifnb1 chromatin structure and represses Ifnb1 gene transcription by preventing recruitment of CBP/p300. These results characterize a previously unknown mechanism of macrophage-specific regulation of Ifnb1 transcription whereby TRIM33 is critical for Ifnb1 gene transcription shutdown

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Range use is related to free-range broiler chickens’ behavioral responses during food and social conditioned place preference tests

International audienceFree-range broiler chickens usually show an uneven spatial utilization of an outdoor range. Due to behavioral and cognitive between-individual differences, some animals may be driven to associate food and conspecifics more strongly to the barn, causing them to be less prone to explore the range. In this study, we aimed to understand how broiler chickens with different ranging levels (low- and high-ranging chickens) would behave under conditioned place preference (CPP) test situations. We used two cohorts conditioned to two natural rewarding stimuli: food and social companions. In a two-chambered apparatus, one cohort (n = 31, 16 high-ranging, and 15 low-ranging chickens) was conditioned to one chamber that always contained a cup with a food reward (mealworms), while the cup in the other chamber was always empty. The same design was also used with the second cohort (n = 31, 15 high-ranging and 16 low-ranging chickens), although instead of food, the reward was the physical presence of two conspecifics. During the testing trials, the animals had access to both empty chambers, and the time spent in each chamber was quantified. For the first day of the food CPP test, both the high- and low-ranging chickens spent significantly more time in the conditioned chamber, where they had previously found mealworms. During the following extinction days, the animals showed a gradual loss of their learned preference, increasing their immobility in the apparatus. High-ranging chickens were more immobile than low-ranging chickens, however, as their number of trials without moving was significantly higher. Unexpectedly, during the first day of the social CPP test, only high-ranging chickens showed a place preference. An overall place preference was observed only on the second day, with no chamber preference during the extinction days. Our results suggest that whether and how a stimulus-reward association occurs for free-range chickens may also be dependent on individual differences and the nature of the reward (food or social). Since associative learning occurs on a daily basis for farmed animals and the way individuals learn or value the reward varies, this research advanced our knowledge of animal behavior and individual cognitive differences that can be highly beneficial in improving animals' living conditions; this new understanding will allow for a more individualized approach to rearing broiler chickens in outdoor systems

Analyse des coûts et de l’efficacité d’une psychothérapie pour le Trouble panique avec agoraphobie versus un traitement combinant la pharmacothérapie et la psychothérapie

La pharmacothérapie et la thérapie cognitive-comportementale (TCC) sont des traitements de choix pour le Trouble panique avec agoraphobie (TPA) mais demeurent généralement dispendieux. La présente étude vise à comparer les ratios coûts/efficacité d’une TCC pour le TPA versus un traitement combinant la TCC à une pharmacothérapie. Quatre-vingt-quatre participants suivent une TCC combinée ou non avec une médication. Ils sont évalués avant et après le traitement ainsi qu’au suivi d’un an et de deux ans. L’efficacité de la thérapie est calculée à partir d’un « Index de fonctionnement global » pour chaque temps de mesure. Les coûts directs et indirects pour leur part, sont calculés grâce à une « Entrevue sur les coûts de la santé ». Les résultats suggèrent que pour une efficacité équivalente, la TCC seule demeure moins dispendieuse qu’une TCC combinée à une pharmacothérapie. Elle offre donc un meilleur ratio coûts/efficacité. Ce ratio tend même à augmenter avec le temps.Pharmacotherapy and cognitive-behavioral therapy (CBT) are efficient treatments for Panic disorder with agoraphobia (PDA) yet they remain expensive. This study aims to compare the cost/effectiveness ratio of a CBT for PDA versus a combined treatment of CBT and pharmacotherapy. Eighty-four people followed a CBT either alone or combined with medication. They have been evaluated before treatment, immediately after, as well as one and two years later. The therapy efficacy is calculated at each assessment according to a “Global Functioning Index”. Direct and indirect costs are calculated with the “Health Cost Interview”. Results suggest that both treatments are equally effective. However, CBT alone is less expensive than CBT with pharmacotherapy. Thus, it offers a better cost-effectiveness ratio that even increases in the long term.La farmacoterapia y el tratamiento cognitivo comportamental (TCC) son tratamientos electivos para el trastorno de pánico con agorafobia (TPA) pero generalmente son costosos. El presente estudio busca comparar las proporciones costos/eficacia de un TCC para el TPA con un tratamiento que combina el TCC con una farmacoterapia. Ochenta y cuatro participantes siguieron un TCC combinado o no con medicación. Fueron evaluados antes y después del tratamiento así como uno y dos años después. La eficacia de la terapia se calcula a partir de un “Índice de funcionamiento global” para cada tiempo de medida. Los costos directos e indirectos, por su parte, son calculados gracias a una “Entrevista para determinar los costos de la salud”. Los resultados sugieren que para una eficacia equivalente, el TCC sólo es menos costoso que un TCC combinado con la farmacoterapia. Éste ofrece entonces una mejor proporción costos/eficacia. Esta proporción tiende incluso a aumentar con el tiempo.A farmacoterapia e a Terapia Cognitivo-Comportamental (TCC) são bons tratamentos para o Transtorno do Pânico com Agorafobia (TPA), mas são, em geral, dispendiosos. O presente estudo visa comparar as relações de custo e eficácia de uma TCC para o TPA em comparação com um tratamento que associa a TCC a uma farmacoterapia. 84 participantes seguiram uma TCC associada ou não a uma medicação. Eles foram avaliados antes e após o tratamento e também depois de um ano e depois de dois anos. A eficácia da terapia foi calculada a partir de um “índice de funcionamento global” para cada tempo de medida. Os custos diretos e indiretos por outro lado, foram calculados graças a uma “entrevista sobre os custos da saúde”. Os resultados sugerem que, para uma eficácia equivalente, a TCC sozinha continua sendo a menos dispendiosa que uma TCC associada com uma farmacoterapia. Ela oferece, então, uma melhor relação de custo e eficácia. Esta relação tende até a aumentar com o tempo

Uninhibited chickens: ranging behaviour impacts motor self-regulation in free-range broiler chickens (Gallus gallus domesticus)

International audienceInhibiting impulsive, less flexible behaviours is of utmost importance for individual adaptation in an ever-changing environment. However, problem-solving tasks may be greatly impacted by individual differences in behaviour, since animals with distinct behavioural types perceive and interact with their environment differently, resulting in variable responses to the same stimuli. Here, we tested whether and how differences in ranging behaviour of free-range chickens affect motor self-regulation performance during a cylinder task. For this task, subjects must refrain from trying to reach a food reward through the walls of a transparent cylinder and detour to its open sides, as a sign of inhibition. Free-range chickens exhibited an overall low performance in the motor self-regulation task (31.33 +/- 13.55% of correct responses), however, high rangers showed significantly poorer performance than the low rangers (23.75 +/- 9.16% versus 40 +/- 12.90%, respectively). These results give further support to the impacts of individual behavioural differences on cognitive performances. This is the first demonstration to our knowledge of a relationship between exploratory tendencies and motor self-regulation for an avian species