La recherche participative en aphasiologie : comment mobiliser les savoirs expérientiels des soignants ?

INTRODUCTION: Strokes are the main cause of aphasia, a language disorder that makes it difficult to communicate with others. In the acute phase, patients are cared for in neurovascular departments. In this acute care context, conducting research among caregivers to gather their experiences of caregiver-patient relationships with regard to aphasic patients can be complex. PURPOSE OF RESEARCH: To propose a participatory research methodology utilizing knowledge arising from the lived experiences of nurses and care assistants in a neurovascular department. METHOD: A qualitative study based on observation was carried out with a view to ensuring that all the stakeholders involved were fully integrated into the field research. The analysis was carried out in a participatory manner with a nurse and a care assistant, using the grounded theory approach. RESULTS: Twenty-one care situations were observed over a three-month period. Following an initial report, eight situations from this group were selected and analyzed following the six stages of grounded theory analysis, four of which were carried out in a participatory manner with a nurse and a care assistant. CONCLUSIONS: Discussing caregivers’ involvement in the research with them beforehand, given their professional constraints, helped maximize their participation throughout the study. The dynamics of the reporting and analysis stages were conducive to utilizing the nurses’ and care assistants’ lived experiences.

Mean species responses predict effects of environmental change on coexistence.

Environmental change research is plagued by the curse of dimensionality: the number of communities at risk and the number of environmental drivers are both large. This raises the pressing question if a general understanding of ecological effects is achievable. Here, we show evidence that this is indeed possible. Using theoretical and simulation-based evidence for bi- and tritrophic communities, we show that environmental change effects on coexistence are proportional to mean species responses and depend on how trophic levels on average interact prior to environmental change. We then benchmark our findings using relevant cases of environmental change, showing that means of temperature optima and of species sensitivities to pollution predict concomitant effects on coexistence. Finally, we demonstrate how to apply our theory to the analysis of field data, finding support for effects of land use change on coexistence in natural invertebrate communities.

At the heart of the COVID-19 crisis: Perceived concerns of changes in long-term cancer care in French women with cancer.

OBJECTIVE: In the COVID-19 crisis context, the main objective of the study is to investigate factors associated with perceived concerns of change in long-term cancer care in patients currently under treatment. METHODS: A French population-based cross-sectional study was performed using an online questionnaire in April 2020. All persons currently receiving cancer treatment and belonging to the Seintinelles Association (https://www.seintinelles.com) were included in this present analysis. Individual sociodemographic characteristics, medical status and information regarding cancer care were collected. Multivariate binomial logistic regression analysis was performed. RESULTS: We included 298 women in the analysis. Younger participants (OR = 0.96 [0.94-0.99]), the need to visit healthcare facilities to receive treatment (OR = 2.93 [1.16-8.52]), deterioration in the quality of communication with the medical team since the beginning of the COVID-19 crisis (OR = 3.24 [1.61-7.02]) and being cared for by a university hospital or a public hospital (OR = 2.19 [1.16-4.23] versus comprehensive cancer centre) were associated with a perceived fear of change in long-term cancer care. CONCLUSION: To address patients' concerns regarding changes in their long-term cancer care, medical teams should consider the patients' own perceptions of the situation and provide clear, appropriate, precise information on cancer care, especially in the centres mostly affected by the COVID-19 crisis.

Factors associated with fear of COVID-19 infection in people living with HIV / Facteurs associés à la crainte de l'infection par la COVID-19 chez des personnes vivant avec le VIH

INTRODUCTION: People living with HIV (PLHIV) who may have experienced biographical disruptions in their life trajectory may have a vulnerability to risk that differs from the general population, particularly in the context of an infectious health crisis. This study aimed to understand the factors associated with concerns about being infected with COVID-19 among PLHIV during the first period of the health crisis. METHODS: This was an online cross-sectional study using an online self-administered questionnaire in the context of the COVID-19 epidemic in France among a population of PLHIV. The recruitment was done via social networks and through various actors in the fight against HIV. The self-questionnaire was available from July 2020 to September 2020. RESULTS: The ACOVIH study collected 249 responses, 202 men and 47 women, with a mean age of 46.6 ± 12.9 years. The most represented socio-professional categories were employees (n=73.29%), followed by managers, professionals and artists (n=59.24%). The PLHIV most worried about being infected by COVID-19 had a level of education lower than or equal to the baccalaureate, family difficulties related to HIV and a deterioration in the relationship of trust with the HIV medical team. CONCLUSION: Feelings of anxiety can have a health and psychosocial impact on PLHIV. It is necessary to consider these negative factors by proposing adapted support and by carrying out preventive actions aiming in particular at improving the literacy of the PLHIV.

Introduction: Les personnes vivant avec le VIH (PVVIH) ayant déjà vécu des perturbations biographiques dans leur trajectoire de vie peuvent avoir une vulnérabilité accrue aux risques, particulièrement dans le cadre d'une crise sanitaire infectieuse. La présente étude (« Adaptations à la COVID-19 lorsque l'on vit avec le VIH ¼ [ACOVIH]) vise à appréhender les facteurs associés à l'inquiétude d'être infecté par la COVID-19 chez les PVVIH durant la première période de la crise sanitaire. Méthodes: Il s'agissait d'une étude transversale en ligne par questionnaire autoadministré conduite dans le contexte épidémique de la COVID-19 sur le territoire français auprès d'une population de PVVIH. Les participants ont été recrutés via les réseaux sociaux et par le biais de divers acteur·trice·s de la lutte contre le VIH. L'autoquestionnaire était disponible de juillet 2020 à septembre 2020. Résultats: L'étude ACOVIH a recueilli 249 réponses, 202 hommes et 47 femmes, d'un âge moyen de 46,6 ± 12,9 ans. Les catégories socioprofessionnelles les plus représentées étaient les employés (n = 73, 29 %), suivis des cadres et des professions intellectuelles et artistiques (n = 59, 24 %). Les PVVIH les plus inquiètes à l'idée d'être infectées par la COVID-19 ont un niveau d'études inférieur ou égal au baccalauréat, des difficultés familiales en lien avec le VIH et une dégradation de la relation de confiance vis-à-vis de l'équipe médicale VIH. Conclusion: Le sentiment d'inquiétude peut avoir un impact sanitaire et psychosocial chez les PVVIH. Il est nécessaire de considérer ces facteurs négatifs en proposant un accompagnement adapté et en menant des actions préventives visant notamment à améliorer la littératie des PVVIH.

Species richness increases fitness differences, but does not affect niche differences.

A key question in ecology is what limits species richness. Modern coexistence theory presents the persistence of species as a balance between niche differences and fitness differences that favour and hamper coexistence, respectively. With most applications focusing on species pairs, however, we know little about if and how this balance changes with species richness. Here, we apply recently developed definitions of niche and fitness differences, based on invasion analysis, to multispecies communities. We present the first mathematical proof that, for invariant average interaction strengths, the average fitness difference among species increases with richness, while the average niche difference stays constant. Extensive simulations with more complex models and analyses of empirical data confirmed these mathematical results. Combined, our work suggests that, as species accumulate in ecosystems, ever-increasing fitness differences will at some point exceed constant niche differences, limiting species richness. Our results contribute to a better understanding of coexistence multispecies communities.

Horizontal and vertical diversity jointly shape food web stability against small and large perturbations.

The biodiversity of food webs is composed of horizontal (i.e. within trophic levels) and vertical diversity (i.e. the number of trophic levels). Understanding their joint effect on stability is a key challenge. Theory mostly considers their individual effects and focuses on small perturbations near equilibrium in hypothetical food webs. Here, we study the joint effects of horizontal and vertical diversity on the stability of hypothetical (modelled) and empirical food webs. In modelled food webs, horizontal and vertical diversity increased and decreased stability, respectively, with a stronger positive effect of producer diversity on stability at higher consumer diversity. Experiments with an empirical plankton food web, where we manipulated horizontal and vertical diversity and measured stability from species interactions and from resilience against large perturbations, confirmed these predictions. Taken together, our findings highlight the need to conserve horizontal biodiversity at different trophic levels to ensure stability.

Reinterpreting the relationship between number of species and number of links connects community structure and stability.

For 50 years, ecologists have examined how the number of interactions (links) scales with the number of species in ecological networks. Here, we show that the way the number of links varies when species are sequentially removed from a community is fully defined by a single parameter identifiable from empirical data. We mathematically demonstrate that this parameter is network-specific and connects local stability and robustness, establishing a formal connection between community structure and two prime stability concepts. Importantly, this connection highlights a local stability-robustness trade-off, which is stronger in mutualistic than in trophic networks. Analysis of 435 empirical networks confirmed these results. We finally show how our network-specific approach relates to the classical across-network approach found in literature. Taken together, our results elucidate one of the intricate relationships between network structure and stability in community networks.

Behavior and gene expression in the brain of adult self-fertilizing mangrove rivulus fish (Kryptolebias marmoratus) after early life exposure to the neurotoxin ß-N-methylamino-l-alanine (BMAA).

ß-N-Methylamino-l-alanine (BMAA), a neurotoxin naturally produced by cyanobacteria, diatoms and dinoflagellates, constitutes a serious environmental and health threat especially during acute blooms, which are becoming more frequent. This neurotoxin is implicated in several neurodegenerative diseases (ND) in humans through contaminated water or food consumption. Even low doses of neurotoxic compounds (NCs) can have lasting effects later in life. In this sense, early stages of development constitute a period of high sensitivity to environmental influence, particularly for the central nervous system. To understand the mechanisms underlying the delayed effects of NCs, newly hatched larvae of the mangrove rivulus fish, Kryptolebias marmoratus, were exposed to two sub-lethal doses of BMAA (20 µg/L and 15 mg/L) for 14 days. This fish naturally produces isogenic lineages due to its self-fertilizing reproduction, which is unique case among vertebrates. It thus provides genetic characteristics that allow scientists to study organisms' true reaction norm, minimizing genetic variability and focusing exclusively on the effects of the environment. Effect assessment was performed at different levels of biological organization to detect inconspicuous effects of BMAA, since this molecule displays long retention in organisms. BMAA effects on life history traits as well as behavioral traits such as boldness and aggressiveness were assessed more than 100 days after exposure. In addition, the relative expression of 7 potential BMAA target genes was studied, given their involvement in neurotransmission or their association with individual variation in boldness and aggressiveness. Selected genes code for reticulon 4 (RTN4), glutamate vesicular transporter 1 (Slc17a7), glutamine synthetase a (Glula), dopamine receptor D4 (DRD4), monoamine oxidase A (MAOA), calmodulin (CaM) and epedymine (Epd). Despite observing no effects of BMAA on growth, reproduction and behavioral traits, BMAA induced a significant increase of the expression of CaM and MAOA genes at 20 µg/L BMAA compared to the control group. A significant decrease of expression was observed between this lowest BMAA dose and 15 mg/L for DRD4, MAOA and CaM genes. Our results suggest disruption of glutamate turnover, intracellular dopamine depletion and activation of astrocyte protective mechanisms, indicating that BMAA might be excitotoxic. Our study revealed that BMAA can have long-lasting effects on the brain that are suspected to affect phenotypic traits with aging. Furthermore, it highlights the importance of studying delayed effects in ecotoxicological studies.

Behavior Change Content, Understandability, and Actionability of Chronic Condition Self-Management Apps Available in France: Systematic Search and Evaluation.

BACKGROUND: The quality of life of people living with chronic conditions is highly dependent on self-management behaviors. Mobile health (mHealth) apps could facilitate self-management and thus help improve population health. To achieve their potential, apps need to target specific behaviors with appropriate techniques that support change and do so in a way that allows users to understand and act upon the content with which they interact. OBJECTIVE: Our objective was to identify apps targeted toward the self-management of chronic conditions and that are available in France. We aimed to examine what target behaviors and behavior change techniques (BCTs) they include, their level of understandability and actionability, and the associations between these characteristics. METHODS: We extracted data from the Google Play store on apps labelled as Top in the Medicine category. We also extracted data on apps that were found through 12 popular terms (ie, keywords) for the four most common chronic condition groups-cardiovascular diseases, cancers, respiratory diseases, and diabetes-along with apps identified through a literature search. We selected and downloaded native Android apps available in French for the self-management of any chronic condition in one of the four groups and extracted background characteristics (eg, stars and number of ratings), coded the presence of target behaviors and BCTs using the BCT taxonomy, and coded the understandability and actionability of apps using the Patient Education Material Assessment Tool for audiovisual materials (PEMAT-A/V). We performed descriptive statistics and bivariate statistical tests. RESULTS: A total of 44 distinct native apps were available for download in France and in French: 39 (89%) were found via the Google Play store and 5 (11%) were found via literature search. A total of 19 (43%) apps were for diabetes, 10 for cardiovascular diseases (23%), 8 for more than one condition in the four groups (18%), 6 for respiratory diseases (14%), and 1 for cancer (2%). The median number of target behaviors per app was 2 (range 0-7) and of BCTs per app was 3 (range 0-12). The most common BCT was self-monitoring of outcome(s) of behavior (31 apps), while the most common target behavior was tracking symptoms (30 apps). The median level of understandability was 42% and of actionability was 0%. Apps with more target behaviors and more BCTs were also more understandable (ρ=.31, P=.04 and ρ=.35, P=.02, respectively), but were not significantly more actionable (ρ=.24, P=.12 and ρ=.29, P=.054, respectively). CONCLUSIONS: These apps target few behaviors and include few BCTs, limiting their potential for behavior change. While content is moderately understandable, clear instructions on when and how to act are uncommon. Developers need to work closely with health professionals, users, and behavior change experts to improve content and format so apps can better support patients in coping with chronic conditions. Developers may use these criteria for assessing content and format to guide app development and evaluation of app performance. TRIAL REGISTRATION: PROSPERO CRD42018094012; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=94012.

mHealth Apps for Self-Management of Chronic Conditions in France: What Is out There?

mHealth apps use is rapidly increasing and has high potential value for people with chronic conditions, supporting behaviour change for self-management and improving patient-provider communication. To build a well-functioning app development environment, we need to examine the range of available apps according to their variability and content. A review of Google Play apps revealed limited availability for chronic self-management in France among substantial unrelated content. Most apps' content was difficult to understand and act upon.

Illness beliefs and emotional responses in mildly disabled stroke survivors: A qualitative study.

BACKGROUND: As acute stroke services improve, more persons experience mild stroke and need to cope daily with hidden disabilities, which may be influenced by how they perceive stroke, cognitively and emotionally. OBJECTIVE: To investigate cognitive illness beliefs and emotional responses in persons with mild stroke and their possible influences on daily coping. METHODS: Semi-structured interviews were conducted with 24 persons with mild stroke, on average 7.5 months (±0.89) after stroke occurrence. A thematic analysis on verbatim transcripts was guided by the Common-Sense Model of Self-Regulation. RESULTS: All participants experienced difficulties constructing an illness identity at both acute and chronic phase. Behavioral risk factors were less accepted as causes of stroke. Lack (or inappropriate timing) of information from healthcare providers led to limited medication knowledge and low perceived control of stroke recurrence which generated anxiety, fear, and low involvement in coping. Participants who considered stroke a chronic condition experienced more difficulties. Perceived support from relatives and healthcare providers was beneficial for participation in recovery and health behaviour change. CONCLUSION: Despite having mildly disabilities, participants reported difficulties developing illness beliefs conducive to coping, and dealing with their emotional responses. These elements should be considered in tailored programs to improve coping with hidden disabilities post-stroke.