Le deuil après suicide : Comment la relation thérapeutique en danse-thérapie peut-elle informer la pratique de la thérapie par l’art dramatique?

Cette recherche théorique qualitative cherche à établir de quelle manière les concepts clefs de la relation thérapeutique propres à la danse-thérapie peuvent être intégrés à une session de thérapie par l’art dramatique afin de soutenir les survivants du suicide. Le deuil après suicide s’avère être une expérience complexe marquée par un sentiment de culpabilité, de honte et d’isolation. Une remise en question majeure des croyances entretenues par rapport au monde ainsi qu’une perte de sens peuvent s’en suivre. Au sein de la relation intersubjective entre le thérapeute et le client, les approches thérapeutiques par les arts créatifs peuvent aider le survivant du suicide à recréer un sens dans l’expérience du deuil. L’empathie kinesthésique, développée au sein de la relation thérapeutique, peut aider la personne à cheminer grâce à l’accompagnement au niveau corporel, émotionnel et cognitif. Il devient possible de briser le silence et l’isolation et d’exprimer l’inexprimable. Les arts deviennent le véhicule d’expression, permettant l’espoir et la transformation. Cette étude inclut une revue littéraire, constituée d’un aperçu historique des approches du soutien au deuil et de perspectives courantes, du deuil après suicide et de l’utilisation des arts auprès des personnes en deuil. Il sera également démontré que la thérapie par l’art dramatique peut soutenir les survivants du suicide grâce à des approches et outils spécifiques. L’empathie kinesthésique sera intégrée dans le contexte de la thérapie par l’art dramatique

Combining the Estimated Date of HIV Infection with a Phylogenetic Cluster Study to Better Understand HIV Spread: Application in a Paris Neighbourhood

International audienceObjectivesTo relate socio-demographic and virological information to phylogenetic clustering in HIV infected patients in a limited geographical area and to evaluate the role of recently infected individuals in the spread of HIV.MethodsHIV-1 pol sequences from newly diagnosed and treatment-naive patients receiving follow-up between 2008 and 2011 by physicians belonging to a health network in Paris were used to build a phylogenetic tree using neighbour-joining analysis. Time since infection was estimated by immunoassay to define recently infected patients (very early infected presenters, VEP). Data on socio-demographic, clinical and biological features in clustered and non-clustered patients were compared. Chains of infection structure was also analysed.Results547 patients were included, 49 chains of infection containing 108 (20%) patients were identified by phylogenetic analysis. analysis. Eighty individuals formed pairs and 28 individuals were belonging to larger clusters. The median time between two successive HIV diagnoses in the same chain of infection was 248 days [CI = 176–320]. 34.7% of individuals were considered as VEP, and 27% of them were included in chains of infection. Multivariable analysis showed that belonging to a cluster was more frequent in VEP and those under 30 years old (OR: 3.65, 95 CI 1.49–8.95, p = 0.005 and OR: 2.42, 95% CI 1.05–5.85, p = 0.04 respectively). The prevalence of drug resistance was not associated with belonging to a pair or a cluster. Within chains, VEP were not grouped together more than chance predicted (p = 0.97).ConclusionsMost newly diagnosed patients did not belong to a chain of infection, confirming the importance of undiagnosed or untreated HIV infected individuals in transmission. Furthermore, clusters involving both recently infected individuals and longstanding infected individuals support a substantial role in transmission of the latter before diagnosis

Cytotoxicity and Antiviral Properties of Alkaloids Isolated from Pancratium maritimum

Ten Amaryllidaceae alkaloids (AAs) were isolated for the first time from Pancratium maritimum collected in Calabria region, Italy. They belong to different subgroups of this family and were identi-fied as lycorine, which is the main alkaloid, 9-O-demethyllycorine, haemanthidine, haemanthamine, 11-hydroxyvittatine, homolycorine, pancracine, obliquine, tazettine and vittatine. Haemanthidine was isolated as a scalar mixture of two 6-epimers, as already known also for other 6-hydroxycrinine alkaloids, but for the first time they were separated as 6,11-O,O′-di-p-bromobenzoyl esters. The evaluation of the cytotoxic and antiviral potentials of all isolated compounds was undertaken. Ly-corine and haemanthidine showed cytotoxic activity on Hacat cells and A431 and AGS cancer cells while, pancracine exhibited selective cytotoxicity against A431 cells. We uncovered that in addition to lycorine and haemanthidine, haemanthamine and pancracine also possess antiretroviral abilities, inhibiting pseudotyped human immunodeficiency virus (HIV)−1 with EC50 of 25.3 µM and 18.5 µM respectively. Strikingly, all the AAs isolated from P. maritimum were able to impede dengue virus (DENV) replication (EC50 ranged from 0.34–73.59 µM) at low to non-cytotoxic concentrations (CC50 ranged from 6.25 µM to >100 µM). Haemanthamine (EC50 = 337 nM), pancracine (EC50 = 357 nM) and haemanthidine (EC50 = 476 nM) were the most potent anti-DENV inhibitors. Thus, this study uncovered new antiviral properties of P. maritimum isolated alkaloids, a significant finding that could lead to the development of new therapeutic strategies to fight viral infectious diseases

Réalités et enjeux de la participation des femmes dans les essais cliniques sur les antirétroviraux : expérience au Sénégal

De plus en plus d'essais cliniques se déroulent dans les pays du Sud. Contrairement aux pays du Nord, où dans les années 1990 les associations critiquaient l'absence de femmes dans les essais, les femmes sont quatre fois plus nombreuses que les hommes parmi les participants lors du dernier d'entre eux mené à Dakar. Cela rend particulièrement aiguë la question de la survenue de grossesses dans les essais. Ce chapitre analyse cette féminisation des participants aux essais, avec la question de savoir si celle-ci résulte des modalités d'inclusion. Le mode de prise en charge des femmes enceintes dans les essais sera présenté et discuté à partir de l'expérience des femmes, des soignants et des chercheurs. Les problèmes que pose la féminisation des participants aux essais cliniques seront discutés, notamment pour ce qui concerne les limites du dispositif de prise en charge en matière de contraception, les dispositions éthiques exigées et la possibilité de critères d'inclusion basés sur le sexe

Efficacy of First-Line Chemotherapy in Patients with Advanced Lung Sarcomatoid Carcinoma

Background:Sarcomatoid carcinomas (SCs) are rare tumors that may arise in the lung, accounting for 0.4% of non–small-cell lung cancers; the prognosis is poor. Only few retrospective small-size series have studied the efficacy of chemotherapy (CT) for metastatic SC.Methods:Multicenter study of patients with advanced or metastatic SC who received first-line CT. Clinical characteristics at baseline, response to first-line CT (Response Evaluation Criteria in Solid Tumors version 1.1), progression-free survival (PFS), and overall survival (OS) were retrospectively collected.Results:Ninety-seven patients were included. Median age was 62 (54–72) years. The majority of patients were men (70%), white (84%), and smokers (84%). Overall, 73% of patients received first-line platinum-based CT. At first tumor evaluation, 69% of patients experienced progression, 31% had disease control, and 16.5% had partial response. Partial response was observed in 20% of patients receiving platinum-based CT, and in none of those receiving non–platinum-based CT (p = 0.018). Median PFS was 2.0 months (confidence interval [CI] 95%: 1.8–2.3). PFS was not statistically different between patients receiving or not receiving a platinum-based CT. Median OS was 6.3 months (CI 95%: 4.7–7.8). There was a trend toward better OS for patients treated with platinum-based CT (7.0 months [CI 95%: 4.9–9.0] versus 5.3 months [CI 95%: 2.8–7.6]; p = 0.096). In multivariate analysis, disease control at first evaluation (hazard ratio = 0.38 [CI 95%: 0.21–0.59]) and at platinum-based CT (hazard ratio = 0.92 [CI 95%: 0.85–0.99]) was associated with better OS.Conclusion:SC is associated with poor prognosis and high rate of resistance to conventional first-line CT. New therapeutic strategies are needed, based on better knowledge of the carcinogenesis of SC

Assessment of the impacts of pets on human health and quality of life

The interest for animal-associated activities and therapy is growing and the impact of these projects on health and quality of life needs to be assessed. Unfortunately, there are major variations in the methodology, objectives and indicators used in these studies. An analysis of the main published articles revealed the limitations of population-based observation studies. Cost-effectiveness studies are much more useful, as long as they comply with the principles of such studies. The main issues, i.e. the nature of what is to be demonstrated, how costs and efficacy are measured, and the cultural background of the project, need to be addressed with special care.Le développement des projets d'activité associant l'animal dans un but thérapeutique rend nécessaire une évaluation de l'impact de ces projets sur la santé et la qualité de vie. Malheureusement les études dans ce domaine sont hétérogènes tant dans leurs qualités méthodologiques, leurs objectifs que dans les indicateurs retenus. L'analyse des principales études publiées invite à considérer avec prudence les études d'observation populationnelles. Les études de type coût/efficacité, ou mieux coût/effectivité, sont à privilégier à condition de bien en respecter les principes. Les questions essentielles portent sur la nature de ce que l'on veut mettre en évidence, la façon de construire les mesures de coût et d'efficacité et le contexte culturel du projet. Elles doivent être résolues avec attention

Efficacy of transcranial direct-current stimulation in women with provoked vestibulodynia

Abstract: Background: Provoked vestibulodynia (PVD) is a highly prevalent condition characterized by acute recurrent pain located at the vaginal entrance in response to pressure application or attempt of vaginal penetration. Despite a wide variety of treatments offered to women with PVD, a high proportion of women are refractory to conventional treatment. Transcranial direct-current stimulation (tDCS) is a non-invasive brain stimulation technique that has been shown effective for improving various chronic pain conditions. Growing evidence suggests that the central nervous system (CNS) could play a key role in PVD. Targeting the CNS could be a promising treatment avenue for women suffering from PVD. Objective: The purpose of this study was to evaluate and compare the efficacy of active and sham tDCS in reducing pain intensity during intercourse in women with PVD. Study design: We conducted a triple-blind, parallel group, randomized controlled trial (RCT). Women, aged between 17-45 years and diagnosed with PVD by a gynecologist using a validated protocol were randomized to 10 sessions of either active tDCS (intensity = 2mA) or 10 sessions of sham tDCS, over a 2-week period. Both active and sham tDCS were applied for 20 minutes, with the anode positioned over the primary motor cortex (M1), and the cathode, over the contralateral supraorbital area. Outcome measures were collected at baseline, 2 weeks after treatment and at 3-month follow-up by an evaluator blinded to group assignation. The primary objective was pain intensity during intercourse, as assessed with a numerical rating scale. Secondary outcomes focused on sexual function and distress, vestibular sensitivity, psychological distress, treatment ,satisfaction and patient impression of change. Statistical analyses were conducted on the intention-to-treat basis, and treatment effects were evaluated using a mixed linear model for repeated measures. Results: A total of 40 women were randomly assigned to received either active (n=20) or sham (n=20) tDCS treatments between November 2014 and February 2016. Baseline characteristics were similar between active and sham tDCS groups. Active tDCS did not significantly reduced pain during sexual intercourse compared to sham tDCS 2 weeks after treatment (p=0.84) and at follow-up (p=0.09). Mean [95% CI] baseline and 2-week assessment pain intensity were respectively 6.8 [5.9 - 7.7] and 5.6 [4.7 - 6.5] for active tDCS (p=0.03) versus 7.5 [6.6 - 8.4] and 5.7 [4.8 - 6.6] for sham tDCS (p=0.001). Non-significant differences between the two groups were also found in regards to sexual function and distress after treatment (p>0.20) and at follow-up (p>0.10). Overall, at 2-week assessment 68% women assigned to active tDCS reported being very much, much or slightly improved compared to 65% of women assigned to sham tDCS (p=0.82), and still comparable at follow-up 42% versus 65%, respectively (p=0.15). Conclusion: Findings suggest that active tDCS is not more effective than sham tDCS for reducing pain in women with PVD. Likewise, no significant effects were found on sexual function, vestibular sensitivity or psychological distress

Estimating Attributable Mortality Due to Nosocomial Infections Acquired in Intensive Care Units

Background. The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken. Objective. TO assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients. Setting. Eleven ICUs of a French university hospital. Design. We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was denned as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis. Results. Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control Patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%—14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%-6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%-3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%-2.5%) for bloodstream infection, and 0.0% (95% CI, -0.4% to 0.4%) for urinary tract infection. Conclusions. ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assesse

Paternal age explains a major portion of de novo germline mutation rate variability in healthy individuals

De novo mutations (DNM) are an important source of rare variants and are increasingly being linked to the development of many diseases. Recently, the paternal age effect has been the focus of a number of studies that attempt to explain the observation that increasing paternal age increases the risk for a number of diseases. Using disease-free familial quartets we show that there is a strong positive correlation between paternal age and germline DNM in healthy subjects. We also observed that germline CNVs do not follow the same trend, suggesting a different mechanism. Finally, we observed that DNM were not evenly distributed across the genome, which adds support to the existence of DNM hotspots