Attitudes du personnel soignant à l’egard des personnes atteintes du SIDA : impact d’un programme de sensibilisation

Le but de cette recherche était d'évaluer l'impact d'un programme de sensibilisation à l'intervention auprès de patients atteints du SIDA chez un personnel soignant expérimenté et un personnel soignant en formation. Ce programme de sensibilisation a pour objectif de permettre aux soignants de se préparer psychiquement à oeuvrer auprès des personnes atteintes. Six groupes d'environ dix personnes visionnent un vidéo présentant une infirmière parlant de ses inquiétudes envers le SIDA. Les personnes sont encouragées à exprimer leurs propres émotions relativement à cette maladie et aux personnes atteintes. Les autres participants constituent le groupe contrôle et n'assistent pas à la rencontre. Tous les sujets (N= 124) ont répondu à des questionnaires d'attitudes et de connaissances sur le SIDA avant et après les rencontres. Les résultats indiquent une amélioration des attitudes face à l'homosexualité ainsi qu'une augmentation des connaissances sur le SIDA. Toutefois, ces observations ne semblent pas associées à une attitude plus favorable à l'égard des personnes atteintes. L'analyse des discussions montre qu'il existe un conflit entre le désir d'aider les patients et le sentiment de honte face à la difficulté d'être empathique à leur égard. Les auteures recommandent que les programmes de formation du personnel soignant visent à réduire ce conflit.The goal of this study was to evaluate the impact of an awareness program aimed at experienced personnel and personnel in training who provide healthcare services to patients with AIDS. The purpose of the program was to prepare healthcare staff psychically in working with patients. Six groups of approximately ten people each watched a video showing a nurse stating her concerns about AIDS. After the video, people were encouraged to express their own emotions regarding the disease and people suffering from it. Other participants making up a control group did not attend the discussion. All subjects (N= 124) completed questionnaires on their attitudes and knowledge about AIDS before and after the discussion. Results show an improvement of attitudes with respect to homosexuality, as well as a better understanding of AIDS. However, these observations do not seem to correspond with a more favourable attitude towards AIDS patients. An analysis of these discussions reveals that there is a conflict between the will to help patients and the feeling of shame when faced with the difficulty of showing empathy. As a result, the authors recommend that training programs aimed at healthcare personnel be geared to alleviate this conflict

La santé mentale par la gestion des projets personnels : une intervention auprès de jeunes retraités

Une intervention axée sur les buts personnels est offerte à des retraités de 50 à 65 ans en vue d’augmenter leur bien-être psychologique et leur santé mentale. Plus spécifiquement, le programme présenté ici a pour objectif de promouvoir l’expression, la planification et la réalisation de projets personnels à travers une démarche d’apprentissage basée sur une approche cognitive. À la suite de l’intervention, les participants du groupe expérimental (n = 117) se sont améliorés significativement comparativement au groupe contrôle (n = 177) sur tous les indices relatifs aux buts et au bien-être subjectif, et cette amélioration s’est maintenue six mois après la fin de l’intervention. Certaines indications permettront une application plus efficace du programme Gestion des buts personnels.A personal goal-based intervention was offered to retired people aged 50 to 65 years with the objective of increasing their subjective well-being and their mental health. More specifically, the program presented here was aimed to promote the setting, planning, and realization of personal projects through a learning process based on a cognitive approach. At the end of the program, the experimental group (n = 117) had improved significantly more than the control group (n = 177) on all the goal and subjective well-being indicators, and this gain was maintained six months later. Some ideas to make the program more effective are discussed.Se ofrece una intervención centrada en las metas personales a jubilados de 50 a 65 años, con el objetivo de aumentar su bienestar psicológico y su salud mental. Más específicamente, el programa aquí presentado tiene como objetivo promover la expresión, planificación y realización de proyectos personales a través de un proceso de aprendizaje basado en un enfoque cognitivo. Después de la intervención, los participantes del grupo experimental (n = 117) mejoraron significativamente en comparación con el grupo de control (n = 177) en todos los índices relativos a las metas y al bienestar subjetivo, y esta mejora se mantuvo seis meses después de terminada la intervención. Ciertas indicaciones permitirán una aplicación más eficaz del programa de Gestión de metas personales.Uma intervenção baseada nos objetivos pessoais é oferecida aos aposentados de 50 a 65 anos com a finalidade de aumentar seu bem-estar psicológico e sua saúde mental. Mais especificamente, o programa apresentado aqui tem por objetivo promover a expressão, o planejamento e a realização de projetos pessoais através de uma abordagem de aprendizagem baseada em uma abordagem cognitiva. Após a intervenção, os participantes do grupo experimental (n=117) melhoraram muito, em relação ao grupo de controle (n=177), em todos os índices relativos aos objetivos e ao bem-estar subjetivo; esta melhoria manteve-se durante seis meses após o fim da intervenção. Algumas indicações permitirão uma aplicação mais eficaz do programa Gestão dos objetivos pessoais

Grandparents as Foster Parents: Psychological Distress, Commitment, and Sensitivity to their Grandchildren

Grandparents are increasingly solicited to become foster parents. This study aims to describe the psychological distress, parental sensitivity, and parental commitment of a group of Quebec foster grandparents. Forty-eight foster parents were assessed in this study, including 12 grandparents. Psychological distress was assessed using the Symptom Checklist–90–R (SCL–90–R®; Derogatis & Lazarus 1994), parental sensitivity using the short version of the Maternal Behavior Q-Sort (Tarabulsy et al., 2009; Pederson & Moran, 1995) and commitment using a semi-structured interview (This is My Baby; TIMB: Bates & Dozier, 1998). Results indicate no difference between foster parents and grandparents as a function of parental characteristics, sensitivity and commitment. However, results show an association between grandparent status and depressive symptoms even after controlling for family income and child externalization. Challenges faced by foster grandparents are discussed as well as their need of support from child welfare protection

« Ça se sépare-tu ça, la femme pis la mère ? » : Services reçus par des femmes vivant dans un contexte de concomitance de violence conjugale et de mauvais traitements envers les enfants

Le présent article fait état des résultats d’une recherche qui visait à documenter les expériences de la maternité des femmes vivant dans un contexte de concomitance de violence conjugale et de mauvais traitements envers les enfants. Les résultats présentent le point de vue de ces femmes, notamment en ce qui a trait à l’intervention des services de santé et des services sociaux avec lesquels elles ont été en contact.This article draws upon a study that investigates women’s experiences of mothering in families presenting a co-occurrence of domestic violence and child abuse. The findings reported in this article examine the women’s perspectives on health and social services’ responses

Involvement of end users in the development of serious games for health care professions education : systematic descriptive review

Background: On the basis of ethical and methodological arguments, numerous calls have been made to increase the involvement of end users in the development of serious games (SGs). Involving end users in the development process is considered a way to give them power and control over educational software that is designed for them. It can also help identify areas for improvement in the design of SGs and improve their efficacy in targeted learning outcomes. However, no recognized guidelines or frameworks exist to guide end users’ involvement in SG development. Objective: The aim of this study is to describe how end users are involved in the development of SGs for health care professions education. Methods: We examined the literature presenting the development of 45 SGs that had reached the stage of efficacy evaluation in randomized trials. One author performed data extraction using an ad hoc form based on a design and development framework for SGs. Data were then coded and synthesized on the basis of similarities. The coding scheme was refined iteratively with the involvement of a second author. Results are presented using frequencies and percentages. Results: End users’ involvement was mentioned in the development of 21 of 45 SGs. The number of end users involved ranged from 12 to 36. End users were often involved in answering specific concerns that arose during the SG design (n=6) or in testing a prototype (n=12). In many cases, researchers solicited input from end users regarding the goals to reach (n=10) or the functional esthetics of the SGs (n=7). Most researchers used self-reported questionnaires (n=7). Conclusions: Researchers mentioned end users’ involvement in the development of less than half of the identified SGs, and this involvement was also poorly described. These findings represent significant limitations to evaluating the impact of the involvement of end users on the efficacy of SGs and in making recommendations regarding their involvement

Differentiating the design principles of virtual simulations and serious games to enhance nurses’ clinical reasoning

Virtual simulations and serious games are e-learning interventions with the potential to enhance nurses' clinical reasoning. However, distinctions in the design principles of each intervention remain ambiguous. Clarifications are needed to distinguish both interventions and ease the articulation between their design principles and the development of clinical reasoning. In this study, we examine the overlapping and unique design principles of virtual simulations and serious games

A Systematic Review of Social Factors and Suicidal Behavior in Older Adulthood

Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness—the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men

Natalizumab treatment shows low cumulative probabilities of confirmed disability worsening to EDSS milestones in the long-term setting.

Abstract Background Though the Expanded Disability Status Scale (EDSS) is commonly used to assess disability level in relapsing-remitting multiple sclerosis (RRMS), the criteria defining disability progression are used for patients with a wide range of baseline levels of disability in relatively short-term trials. As a result, not all EDSS changes carry the same weight in terms of future disability, and treatment benefits such as decreased risk of reaching particular disability milestones may not be reliably captured. The objectives of this analysis are to assess the probability of confirmed disability worsening to specific EDSS milestones (i.e., EDSS scores ≥3.0, ≥4.0, or ≥6.0) at 288 weeks in the Tysabri Observational Program (TOP) and to examine the impact of relapses occurring during natalizumab therapy in TOP patients who had received natalizumab for ≥24 months. Methods TOP is an ongoing, open-label, observational, prospective study of patients with RRMS in clinical practice. Enrolled patients were naive to natalizumab at treatment initiation or had received ≤3 doses at the time of enrollment. Intravenous natalizumab (300 mg) infusions were given every 4 weeks, and the EDSS was assessed at baseline and every 24 weeks during treatment. Results Of the 4161 patients enrolled in TOP with follow-up of at least 24 months, 3253 patients with available baseline EDSS scores had continued natalizumab treatment and 908 had discontinued (5.4% due to a reported lack of efficacy and 16.4% for other reasons) at the 24-month time point. Those who discontinued due to lack of efficacy had higher baseline EDSS scores (median 4.5 vs. 3.5), higher on-treatment relapse rates (0.82 vs. 0.23), and higher cumulative probabilities of EDSS worsening (16% vs. 9%) at 24 months than those completing therapy. Among 24-month completers, after approximately 5.5 years of natalizumab treatment, the cumulative probabilities of confirmed EDSS worsening by 1.0 and 2.0 points were 18.5% and 7.9%, respectively (24-week confirmation), and 13.5% and 5.3%, respectively (48-week confirmation). The risks of 24- and 48-week confirmed EDSS worsening were significantly higher in patients with on-treatment relapses than in those without relapses. An analysis of time to specific EDSS milestones showed that the probabilities of 48-week confirmed transition from EDSS scores of 0.0–2.0 to ≥3.0, 2.0–3.0 to ≥4.0, and 4.0–5.0 to ≥6.0 at week 288 in TOP were 11.1%, 11.8%, and 9.5%, respectively, with lower probabilities observed among patients without on-treatment relapses (8.1%, 8.4%, and 5.7%, respectively). Conclusions In TOP patients with a median (range) baseline EDSS score of 3.5 (0.0–9.5) who completed 24 months of natalizumab treatment, the rate of 48-week confirmed disability worsening events was below 15%; after approximately 5.5 years of natalizumab treatment, 86.5% and 94.7% of patients did not have EDSS score increases of ≥1.0 or ≥2.0 points, respectively. The presence of relapses was associated with higher rates of overall disability worsening. These results were confirmed by assessing transition to EDSS milestones. Lower rates of overall 48-week confirmed EDSS worsening and of transitioning from EDSS score 4.0–5.0 to ≥6.0 in the absence of relapses suggest that relapses remain a significant driver of disability worsening and that on-treatment relapses in natalizumab-treated patients are of prognostic importance

Le dispositif prudentiel Bâle II, autoévaluation et contrôle interne : une application au cas français

The operations of banks have profundly changed in recent years, due to financial liberalization and technological innovations. The development of new financial instruments and globalization of capital markets has generated new risks and forced supervisors to changing regulatory requirements to ensure the resilience of the financial system. With the entry into force in December 2006 of the reform of Basel II, banks have had to adapt their tools for selecting and measuring credit risk and taking into account operational risks in computing requirements equity. This thesis focuses on the passage of agreements Basel I to Basel II and explains the development of prudential based reform. The shift between the ratio Cooke and the ratio Mac Donough, is presented and analyzed to illustrate the "rise" of the self and demonstrate that internal control emerged as the cornerstone of the new device. A study of the internal control in force in France, particulary via regulation No. 97-02 modified of Comittee on Banking and Financial Regulation, is conducted. Then, from a qualitative study conducted in a french cooperative bank, we offer guides to key controls, in terms of governance and by type of risk.Les modes de fonctionnement des établissements bancaires ont profondément évolué ces dernières années, sous l'effet de la libéralisation financière et des innovations technologiques. Le développement de nouveaux instruments financiers et la globalisation du marché des capitaux ont généré de nouveaux risques et contraint les autorités prudentielles à faire évoluer les exigences réglementaires pour garantir la résilience du système financier. Avec l'entrée en vigueur, en décembre 2006, de la réforme "Bâle II", les banques ont dû adapter leurs outils de sélection et de mesure du risque de crédit et prendre en compte les risques opérationnels dans le calcul d'exigences de fonds propres. Cette thèse s'intéresse au passage des Accords de Bâle I à Bâle II et explique les évolutions prudentielles qui fondent cette réforme. Le passage du ratio Cooke au ratio Mac Donough, est présenté et analysé pour illustrer la "montée en puissance" de l'autocontrôle et démontrer que contrôle interne apparaît désormais comme la pierre angulaire du nouveau dispositif. Une étude du dispositif de contrôle interne en vigueur en France, notamment via le réglement n° 97-02 modifié du Comité de la Réglementation Bancaire et Financière, est présentée. Puis, à partir d'une étude qualitative menée au sein d'une banque coopérative française, nous proposons des grilles de lecture des contrôles clés, en terme de gouvernance et par typologie de risques