Comparative risk judgments and actual risk-taking in sexual behaviours

HIV infection still represents a major health problem. Risk-taking or the absence of precautionary behaviour is the first determinant for infection. Comparative risk could help explain some part of the risk-taking. However the relation to actual behaviour bears major methodological difficulties which we attempted to address here. Risk status and situation conditionality were considered as independent variables. Comparative risk estimates were considered dependent variables. Two hundred and sixty eight students were included in a correlational design. They filled in self-questionnaires and reported their risk status concerning HIV infection and comparative risk estimates for both conditional and unconditional risk situations. Results confirmed previous research where estimates varied according to risk status and conditionality was related to lower optimistic bias or increase pessimistic bias. When both variables are considered simultanously, risk-takers appraised comparative risk less pessimistically. Different interpretations accounting for this phenomenon are considered.L'infection au VIH représente encore un problème de santé publique majeure. La prise de risque ou l'absence de comportement de protection est le facteur causal déterminant de l'infection. Le risque perçu comparatif pourrait en partie rendre compte de ce facteur. Cependant la relation directe avec le comportement recèle des difficultés méthodologiques importantes, auxquelles nous tentons de nous adresser ici. Nous considérons deux variables indépendantes, le caractère à risque ou non des sujets et le caractère conditionnel ou non des situations proposées pour l'évaluation subjective des risques comparatifs. Cette dernière évaluation est notre variable dépendante observée. 268 étudiants ont été inclus dans cette étude corrélationnelle. Ils ont rempli des questionnaires autoadministrés portant sur les comportements sexuels et des estimations de risques comparatifs. Les résultats confirment les recherches précédentes où l'estimation subjective des risques varie en fonction du caractère à risque des sujets et du caractère conditonnel des situations. Lorsque les deux variables indépendantes sont considérées simultanément, on observe que les preneurs de risque jugent certaines situations conditionelles de manière moins pessimiste que le reste de l'échantillon. Différentes interprétations de ce phénomène sont envisagées

ROLE OF THE HOGGAR MASSIF ON THE WEST AFRICAN MONSOON ONSET

It has been observed that the West African monsoon onset is concomitant with the enhancement of the Saharan heat low. We show here through a combined diagnostic and modeling study a possible interaction between northern Africa orography and the deepening of the Saharan heat low at the time of the monsoon onset. The amplification of an anticyclonic circulation above and north of the Hoggar massif leads to an increase and a southeasterly-northeasterly rotation of the wind ahead of the Hoggar which contribute to an increased leeward-trough effect enhancing the Saharan heat low. The Atlas does not play any role during the monsoon onset but contributes to the mean climatological location of the Saharan heat low

Changes in hair cortisol and self-reported stress measures following mindfulness-based stress reduction (MBSR) : a proof-of-concept study in pediatric hematology-oncology professionals

Background and purpose Little data is available on the effect of mindfulness amongst pediatric hematology-oncology professionals. The purpose was to further document change in biological and psychological stress following a mindfulness-based stress reduction (MBSR) program. Materials and methods We led two pre-post interventional studies (n = 12 and n = 25) and measured changes on hair cortisol concentrations, perceived stress, psychological distress and burnout. Results Professionals did not change on biological stress (d = 0.04), but improved on self-reported measures (median d = 0.58). Effects were maintained over 3 months for psychological distress, anxiety, depression, and burnout (median d = 0.66). Effects were larger if trainees participated to the retreat and if they reported higher baseline perceived stress. Conclusion In pediatric hematology-oncology professionals, an MBSR program was related with improvements in self-reported stress over 3 months. Components of the program and characteristics of trainees may influence the impact of MBSR

Le deuil des conjoints après un cancer (entre évaluation et expérience subjective)

En 2011, en France, plus de 147 525 hommes et femmes sont morts d un cancer. Cette pathologie ne touche pas seulement les personnes les plus âgées : 41 000 décès prématurés, survenant avant 65 ans sont dus au cancer (FRANCIM, InVS, CIRC). Ce sont autant de personnes qui vivaient potentiellement en couple. En cas de décès, des bouleversements plus ou moins pérennes vont toucher le conjoint, sur un plan psychique, physique et social. Les proches du patient cancéreux constituent l une de ses premières sources de soutien tout au long de sa maladie. Différentes recherches menées ces dernières années ont souligné la vulnérabilité psychique de ces aidants-soignants , notamment en termes de symptômes anxio-dépressifs. Les facteurs de risque sociodémographiques identifiés (comme le fait d être une femme, d être plus âgé, et l existence de deuils antérieurs) ne prennent pas en compte le fonctionnement psychique et affectif des conjoints : les relations de l aidant au malade, sa personnalité, ni même son vécu subjectif de la maladie et de la fin de vie. Lorsque l issue du cancer est fatale, il semble que parmi les proches, ce soient les conjoints des patients qui rencontrent le plus de difficultés pour faire face au décès : le risque de deuil compliqué (Prolonged Grief Disorder, Prigerson et al, 2009) serait plus important dans cette population. A l heure actuelle, l existence de cette catégorie nosographique fait encore débat et les données empiriques longitudinales font défaut pour spécifier le caractère pathologique du deuil dans le champ du cancer. Les propositions de soutien psychologique pour ces personnes si intensément sollicitées restent finalement méconnues, à la fois par les conjoints endeuillés, qui y ont rarement recours, et par certains professionnels du soin. ObjectifsCette recherche a pour objectif d identifier et de comprendre les déterminants des processus de deuil chez les conjoints, amorcés dès la fin de vie de la personne atteinte de cancer en phase palliative, et déployés à moyen et long terme. Cette étude vise également à décrire la phénoménologie normale du deuil, ainsi que ses manifestations pathologiques. La proposition d outils de réflexion favorisant la mise en place de dispositifs de soutien adaptés aux conjoints endeuillés, constitue le dernier objectif de cette recherche.MéthodesDeux études ont été réalisées. L étude 1, quantitative, utilise une batterie psychométrique évaluant la détresse émotionnelle, l ajustement social, le développement post-traumatique, les styles d attachement et de coping, et enfin la personnalité des conjoints. Cette étude propose un suivi de cohorte durant la phase palliative (N=60)/6 mois après le décès (N=36) où l on met en relation des données personnelles initiales avec l ajustement ultérieur des conjoints de patients. L étude 2, qualitative, propose une exploration de l expérience personnelle de dix conjoints confrontés à la perte et de leurs processus de mise en sens à l aide de l Interpretative Phénoménological Analysis (IPA, Smith, Flowers, & Larkin, 2009). Résultats Les analyses quantitatives ont montré que la grande majorité des conjoints présentaient pendant la phase palliative une symptomatologie dépressive et souffraient d un fardeau lié à la prise en charge du malade, tandis que leur adaptation sociale semble globalement préservée. Après la mort du patient, l intensité des symptômes dépressifs augmente pour la majorité des conjoints endeuillés (53%), tandis qu une minorité (13%) souffre d un trouble du deuil prolongé. La détresse des conjoints endeuillés est avant tout prédite par leur niveau de dépression mesurée avant le décès, et peu par les variables liées à la maladie ou au décès lui-même. Les styles d attachement permettent d autre part d identifier des profils adaptatifs chez les conjoints....In 2011, in France, more than 147 525 men and women died through cancer. This disease doesn t affect only the oldest: 41 000 untimely deaths, before 65 years, are caused by cancer (FRANCIM, InVS, CIRC). All these persons were supposed to live with a partner. Faced with the patient s death, more or less sustainable psychological, physical or social upheavals will affect the spouse.The cancer patient s relatives and family constitute one of the patient s main sources of support throughout the disease, but this support is not always recognized by physicians. Over recent years, several studies have emphasized the psychological vulnerability of these caregivers especially in terms of anxiety and depression patterns. However, identified sociodemographic risk factors (e.g. being a woman, being older, and having experienced previous grief) do not take into account the socio-affective and cognitive functioning of the patient s spouse. The relationship with the patient, the caregiver s personality, or the subjective experience of illness and end of life are considered to be critical by clinicians, but are largely ignored in empirical research. When the outcome of cancer is fatal, among the patient s family and friends, the spouse appears to encounter the greatest difficulties to cope with her/his grief: the risk of complicated grief is more considerable among this population. Currently, the existence of this disorder (Prolonged Grief Disorder, Prigerson et al, 2009) still remains in debate and the lack of empirical longitudinal data to specify the pathological aspect of grief in the field of cancer, hinders any scientific consensus.Psychological support provided to these intensely requested persons remains poorly known, both by bereaved spouses, who have rarely resort to support facility, and by some healthcare professionals. AimsThis study aims at identifying and understanding the predictors of grief among bereaved spouses of cancer patients, induced from end of life to the mid- and long- term grief period. We also want to describe the normal phenomenology of grief, and its complicated manifestations. Finally this research aims at providing reflection tools facilitating the implementation of adapted support programs for bereaved spouses.MethodsTwo complementary studies were conducted. Study 1, a quantitative study, uses a psychometric battery assessing the distress, the social adjustment, the post-trauamtic growth, the styles of attachment and of coping, as well as the personality in spouses of cancer patients. This study consists of following-up of a cohort during the palliative period (N=60)/6 months after death (N=36), to capture correlations between initial personal data and subsequent adjustment. Study 2 is a qualitative study, which provides an investigation of ten spouses experience facing the loss of their loved one. This experience and their making sense processes were studied with the Interpretative Phénoménological Analysis (IPA, Smith, Flowers & Larkin, 2009)ResultsThe quantitative analyses showed that the vast majority of the spouses reported during the palliative phase a depressive symptomatology and feelings of burden associated with the caregiving of the patient. Their social adaptation is globally preserved. After the death of the patient, the intensity of the depressive symptoms increase for the majority of the bereaved spouses (53%), while a minority (13%) meet the criteria for a Prolonged Grief Disorder. Above all, the distress of the latter is predicted by their levels of depression assessed before the death. The factors linked to the disease or to the death itself hardly constitute good predictors of the condition of the bereaved spouses. The attachment styles allow us to identify adaptative profiles in this population.....PARIS5-Bibliotheque electronique (751069902) / SudocSudocFranceF

Identifying domains of quality of life in children with cancer undergoing palliative care : a qualitative study with professionals

Objective: The goal of pediatric palliative care (PPC) is to maintain the quality of life (QoL) of children whose lives are threatened. However, there are sparse scientific data on the domains of QoL in this particular context, and no measurement strategies are available. The present study aims to describe the domains of QoL in the context of PPC in oncology, according to the perceptions of professional caregivers. Method: Semistructured interviews were conducted with a random sample of 20 professional caregivers from the Division of Hematology/Oncology at Le Centre Hospitalier Universitaire Sainte-Justine (Montréal, Canada). The caregivers were asked about their perceptions about the QoL of the children they have cared for in this context. The data were analyzed using inductive thematic content analysis. Results: The analysis allowed us to identify seven domains of QoL: “physical comfort,” “alleviation of psychological suffering,” “fun and the present moment,” “sense of control,” “feeling valued and appreciated,” “feeling that life goes on,” and “meaningful social relationships.” Significance of Results: Caregivers recount the regard that should be accorded to maintaining well-being and a sense of fun, as well as fostering the child's abilities, taking account of the progression of the disease, and to fulfilling his or her needs, especially social ones. Our results also demonstrate that all domains were positively referred to by professional caregivers. The data from our study will lead to better assessment of QoL according to the trajectory of a child with advanced cancer while undergoing PPC

Development and inter-rater reliability of a tool assessing hypnotic communication behaviours adopted by nurses caring for children with cancer : The Sainte-Justine Hypnotic Communication Assessment Scale

Background Several studies in pediatric oncology have shown the successful effects of using hypnotic communication techniques (HCTech) during painful medical procedures. Since no studies assessed the precise use of these techniques with a validated tool, it is unsure that the observed relationships involve the use of HCTech. Objectives To develop a scale evaluating healthcare professionals’ behaviours when using HCTech and to evaluate its inter-rater reliability. Methods This study involved the preliminary steps of the Sainte-Justine Hypnotic Communication Assessment Scale (SJ-HCAS) development process. As part of a larger intervention study, the SJ-HCAS was developed in three steps by five experts and four lay raters using an iterative process applied to subsets of video-recorded nurse-patient interactions. The development aimed to maximize clarity and precision of items as well as minimize redundancy amongst items. Inter-rater reliability was assessed in a randomly selected sample of 1/3 of collected video-recorded interactions (n = 42). Results The final version of the scale is composed of 11 items categorized in two domains pertaining to Relationship and Technique. We found excellent inter-rater reliability for both subscores and total score in two independent inter-rater comparisons (median ICC = 0.879), with most items showing very good to perfect inter-rater reliability (median Kappa = 0.847). Conclusions The results support further work with the SJ-HCAS. The scale has the potential to help ensure the integrity of hypnotic communication training in children which could ultimately promote the dissemination of the practice of HCTech

Quality of life, treatment beliefs, and treatment satisfaction in children treated for primary immunodeficiency with SCIg

Despite the development of subcutaneous treatment, children and adolescents with primary immunodeficiency (PID) are vulnerable to a lower quality of life (QoL) than non-clinical participants. Comparisons have been offered in rare reports with limited sample sizes. No description is available of treatment beliefs and treatment satisfaction with standard tools. The objective of this study was to describe a large sample of patients with pediatric PID on QoL, treatment beliefs and satisfaction, and identify perceived benefits and issues of treatment both in children and parents. A mail-back survey was conducted in 60 patients with PID treated with subcutaneous Ig and their parents from a clinic in Montreal (QC, Canada). We used the standardized tools to assess for QoL levels, beliefs of necessity and concerns with treatment, and dimensions of satisfaction. We collected and coded perceived benefits and issues through open-ended questions. We found lower QoL in children with PID than in healthy non-clinical participants (median d = 0.40) and similar QoL levels to children with cancer (median d = 0.12). Participants considered their treatment as less necessary and able to control the illness and less convenient than patients with other conditions. Children were more prone to consider the treatment as convenient (69 vs. 47% p = .028) but reported more discomfort (24 vs. 10% p = .043) than parents. Results suggest a lower-than-expected QoL in pediatric PID. Aspects of the illness and treatment are probably unclear to patients and their families, as necessity beliefs were lower than expected. Educational strategies should be developed and assessed to address this issue

Do professionals change their communication behaviours following a training in hypnosis-derived communication? : a feasibility study in pediatric oncology

Objectives The purpose of this study was to test the feasibility of a training in hypnotic communication techniques (HCTech) for pediatric nurses to prevent procedural pain and distress in children during venipunctures. Specifically, this study aimed to (1) assess nurses’ mastery of HCTech and (2) nurses’ experience regarding the training program. Methods Participants were 6 female pediatric nurses and 33 of their cancer patients. Nurses took part in a 4-day theoretical and practical training in HCTech. Venipuncture procedures were video-recorded and assessed to evaluate nurses’ mastery of HCTech using a standardized scale. Pre-training use of HCTech was compared with post-training and follow-up for the entire nurse sample and across nurses with the same patients (109 nurse-patient interactions). After the follow-up, nurses were questioned about their experience in regards to the training and activities (themes and practice). Results Results showed medium pre-post changes in hypnotic communication behaviours (pre-post d = 0.74), with changes maintaining at follow-up (pre-follow-up d = 0.97). Interviews transcripts’ analyses revealed moderate levels of motivation and satisfaction regarding the training content and format. Nurses suggested to emphasize on the practice of HCTech in a noisy outpatient clinic as well as offer more practical exercises. Conclusion A 4-day training in hypnotic communication techniques translated into the use of HCTech by nurses practicing in pediatric oncology when comparing the same dyads at baseline, post-training and follow-up. Results support further refinement and suggest nurses could be trained to prevent pain and distress with hypnosis-derived communication strategies

A portrait of self-reported health and distress in parents whose child died of cancer

Grieving a child following cancer is a substantially difficult task. The objectives of this research were: 1) to describe current quality of life (QoL), psychological distress and symptoms of grief of bereaved parents, and 2) to explore the role of possible contributors of QoL and psychological distress. Forty-six parents (32 mothers) of children who died of cancer were surveyed on their QoL, distress, and complicated grief. Data were analyzed using multiple linear regression. Parents had a high frequency of grieving symptoms (58%). Mothers reported more retrospective grief symptoms than fathers when describing the year after child death. Current lower mental well-being was associated with experiencing higher retrospective grief symptoms, a shorter period since child death, and being a father. Hence, parents experienced disturbances even long after child death. Mothers and fathers may present specificities that should be considered when developing supportive activities for this vulnerable population

Does practising hypnosis-derived communication techniques by oncology nurses translate into reduced pain and distress in their patients? : an exploratory study

Objectives: To explore the effects of a hypnotic communication (HC) training for pediatric nurses in decreasing patients’ pain and distress during venipunctures. Methods: A 4- day theoretical and practical HC training was offered to 5 pediatric oncology nurses. The effects of HC were tested with 22 young cancer patients (13 girls, 9 boys, 10±4 years) over 4 timepoints, with 88 encounters being video-recorded and coded in stable professional-patient dyads. Patients’ pain and distress were rated by patients and parents with visual analogue scales and coded from recordings using the Faces, Legs, Activity, Cry and Consolability (FLACC) scale. Results: We observed a significant decrease in pre-post distress reported by parents (d=0.45, p=0.046). Two (out of 5) nurses with higher skills acquisition had larger reduction in patients’ self-reported pain (d=1.03, p=0.028), parents perceived pain (d=1.09, p=0.042), distress (d=1.05, p=0.043) as well as observed pain (d=1.22 p=0.025). Favorable results on pain and distress did not maintain at follow-up. Conclusion and clinical implications: Training nurses in HC may translate into improved pain and distress in patients, both self-rated and observed provided that skills are used in practice. HC training is a promising non-pharmacological intervention to address pain in pediatrics