[Pain and depression: cognitive and behavioural mediators of a frequent association]. / Douleur et dépression : les médiateurs cognitifs et comportementaux d'une association très fréquente.

LITERATURE FINDINGS: The comorbidity between chronic pain and depression is high: in the general population setting, the odds ratio for suffering from one of these disorders when suffering from the other is estimated around 2.5. For chronic pain patients consulting in pain clinics, the comorbidity rate reaches one third to half of the patients. For the International Association for the Study of Pain (IASP), pain consists in an emotional as well as a sensory dimension, both of them have to be assessed systematically. Likewise, affective disorders must be systematically depicted in chronic pain patients. The reasons for such comorbidity are complex and result from the conjunction of common risk factors (environmental and genetic vulnerability factors) and of a bidirectional causality. THE TRANSACTIONAL MODEL OF STRESS AND COPING OF LAZARUS ET FOLKMAN: The appraisal stress model (Lazarus and Folkman, 1984) offers an opportunity to understand how chronic pain can cause depression. Pain is conceptualized as a chronic stress. Its appraisal in terms of loss, injustice, incomprehensibility or changes (primary appraisal), and in terms of control (secondary evaluation) determine how the subject will cope with pain. Several personality traits as optimism, hardiness or internal locus of control play a protective role on these evaluations, whereas others (neuroticism, negative affectivity or external locus of control) are risk factors for depression. Low perceived social support is also related to depression. On the contrary, self-efficiency is linked with low levels of depression. Self-management therapies focus on increase of perceived control of pain by the patient in order to improve his/her motivation to change, and to let the patient become active in the management of his/her pain. CONCLUSION: According to Lazarus and Folkman (1984), coping strategies are the constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing on or exceeding the resources of the person. Pain patients can use a wide variety of pain coping strategies: problem versus emotion focused strategies or cognitive versus behavioural strategies. Some of them are highly dysfunctional, such as catastrophizing (cognitive strategy) or avoidance (behavioural strategy). Their preferential use can lead to the development of a depressive episode. The "fear-avoidance model" (Vlayen, 2000) explains pain chronicization by a vicious circle that begins with the pain catastrophizing; this leads to fear of pain, which in turn leads to avoidance and finally to pain and depression. This is why some behavioural cognitive interventions focus on the reduction of catastrophizing and avoidance. Some functional pain coping strategies were identified: they are active strategies centred on problem resolution such as distraction, reinterpretation or ignorance of pain sensations, acceptance, and exercise and task persistence. New therapeutic interventions focus on the development of better coping strategies such as distraction, relaxation and acceptance.

[Psychometric properties of the French adaptation of the Family Relationship Index (FRI)]. / Qualités psychométriques de l'adaptation française du Family Relationship Index (FRI).

OBJECTIVE: The aim of the present study was to investigate the psychometric properties of the French adaptation of the Family Relationship Index (FRI) from Moos and Moos. The FRI is a self-report inventory which consists of 27 items assessing family relations. It is composed of three dimensions: family cohesion, family expressiveness (of feelings and emotions) and family conflict. METHOD: The FRI was translated and adapted into French according to published recommendations. After appropriate cultural adaptations, the scale was administered to a sample of 976 students with a mean age of 21.9 years and 43.5% of men. The participants completed the FRI and three other questionnaires: the Family Adaptability and Cohesion Scale (FACES), the Satisfaction with Life Scale and the General Health Questionnaire. Confirmatory factor analyses were used to test different models with one and three factors. The psychometric properties of the short version of the FRI, proposed by Kissane and Bloch (2002) and composed of 12 items, were also studied. RESULTS: Confirmatory factor analyses showed that the three factors solution was more relevant that the one factor solution (for Khi(2)/ddl, Root mean square error of approximation [RMSEA], Root mean square residual [RMR], Goodness of fit index [GFI], Adjusted goodness of fit [AGFI] and Comparative fit index [CFI]). However, three items belonging to family expression explained a small variance. Therefore, a version consisting of 24 items seemed more appropriate than the 27 items version proposed by Moos and Moos. Cultural differences may explain these results. Internal consistency was satisfactory for cohesion (0.79) and conflict (0.71) but weak for expression (0.55 for 27 items version and 0.62 for 24 items version). One month test-retest reliability showed high correlations for the three dimensions (from 0.77 to 0.85). Correlation between the cohesion subscale of the FRI and the cohesion subscale of the FACES was high (0.77), showing a good convergent validity. The correlations between the three FRI dimensions and the Satisfaction with Life Scale and the General Health Questionnaire were quite low (from -0.31 to 0.41). High family cohesion and high family expression were associated with high life satisfaction and good mental health. Conversely, high family conflict was associated with low life satisfaction and weak mental health. These results support the criterion validity of the FRI. Concerning the 12 items version of the FRI, the factor analysis results showed very good psychometric qualities. However, this short version had lower internal consistency (which ranged between 0.50 and 0.71), test-retest reliability (which ranged 0.68 and 0.81), convergent (0.69 for cohesion) and criterion validity (from -0.21 to 0.37 for the Satisfaction with Life Scale and from -0.28 to 0.19 for the General Health Questionnaire) than the longer versions. CONCLUSION: The results of the present study show that the FRI's 24 items version seems to be the more relevant. Nevertheless, the 12 items version shows interesting qualities. Further studies should confirm these results on other samples. Given the lack of French-language surveys assessing family relations, the FRI will be a useful tool for research and clinical practice.

Older People Facing the Crisis of COVID-19: Between Fragility and Resilience.

The health crisis we are facing is challenging seniors' resources and capacities for adaptation and resilience. The PACOVID survey, set up a few days after containment, investigates their psychological and social experiences with regard to the COVID-19 crisis and to what extent these characteristics, representations and attitudes have an impact on health and mortality. A telephone survey is being carried out on 935 people already followed up in the framework of ongoing epidemiological studies. As we are writing this article, the interviews conducted during the containment have just ended. Even though we will have to wait for the analysis of the results to draw conclusions, words collected by the psychologists during the interviews already illustrate a great heterogeneity in the way older adults lived this experience: social isolation, anxiety, the importance of family and the difficulty of being deprived of it, but also remarkable coping skills and resilience capacities.

[Pain coping strategies: French adaptation of the coping strategies questionnaire (CSQ-F)]. / Stratégies de coping des patients douloureux: adaptation française du coping strategies questionnaire (CSQ-F).

BACKGROUND: Many studies have shown that the strategies used to cope with chronic pain play a very important role in the adjustment to the pathology and to its effects (emotional distress, physical and psychosocial impairment, and quality of life). Among the methods assessing coping with pain, the most widely used instrument at present is the coping strategies questionnaire (CSQ) developed by Rosenstiel and Keefe, [Pain 17 (1983) 33-44]. This questionnaire is composed of 48 items distributed in eight subscales each including six items: diverting attention, reinterpreting pain sensations, coping self-statements, ignoring pain sensations, praying and hoping, catastrophizing, increasing activity level, and increasing pain behaviour. Most studies examining the factor structure of the CSQ have used the scores of its eight prior theoretically derived scales rather than the 48 items. Three studies, Tuttle et al. [Rehab Psychol 36 (1991) 179-187], Swartzmann et al. [Pain 54 (1994) 311-316; Robinson et al. [Clin J Pain 13 (1997) 43-49] have examined the factor structure of the CSQ from the 48 original items on the questionnaire and have yielded five or six factors. A structural confirmatory analysis showed the superiority of the six-factor model [Clin J Pain 13 (1997) 156-162]: distraction, catastrophizing, ignoring pain sensations, distancing from pain, coping self-statements and praying. The present study aimed at measuring the internal consistency and the construct validity of the French version of the CSQ. METHOD: The CSQ was translated into French with the forward and backward translation procedure. To evaluate internal consistency, Cronbach's alphas were computed. Construct validity of the questionnaire was estimated through confirmatory factor analysis (CFA) in a sample of 330 chronic pain patients (71% of women): 40.3% suffered from low back pain, 33.6% from headaches and 26.1% from neuropathic pain. The three factor structures previously proposed in the literature were tested using the LISREL 8.3 structural equation-modelling program developed by Jöreskog and Sörbom, [Lisrel 8: user's reference guide, Chicago: Scientific Software International, 1993]. RESULTS: The CFA performed on the three models of factor structures of the CSQ previously reported confirms the best fit of the six-factor model by Robinson et al. [Clin J Pain 13 (1997) 43-49] in our sample. However, the coping self-statements factor, whose internal consistency was too weak in our analysis (Cronbach's alpha=0.57), was eliminated. We therefore retained only five factors in our sample. The French version of the CSQ (CSQ-F) is composed of 21 items belonging to five factors: distraction, catastrophizing, ignoring pain sensations, reinterpreting pain sensations, and praying. CONCLUSIONS: The present study indicates that the internal consistency and the construct validity of the French version of the CSQ were adequate, and contributes to demonstrate the stability of the factor structure of the CSQ across samples. The 21-item French adaptation of the CSQ (CSQ-F) appears to be a very interesting tool because it facilitates the use of this questionnaire, not only for research but also in the clinical assessment of the patients suffering from chronic pain.

[Asthma education - the patient's response. The results of an automated analysis of an interview]. / L'éducation thérapeutique: le discours du patient asthmatique. Résultats d'une étude d'analyse automatique du discours.

INTRODUCTION: Asthma education is a subject of topical interest and is included in the current guidelines. Everyone agrees on the importance of the concepts of the disease in determining the patient's therapeutic behaviour but there have been few studies of the patient's views on asthma education. METHODS: 42 asthmatics replied to an interview bearing on the following themes: asthma in daily life, therapeutic education and methods of education. The interviews were analysed by the ALCESTE software programme (analysis of co-occurrent lexemes in the simple wording of a text) that extracts the major significant components of a text. RESULTS: The first theme was dominated by thoughts about treatment, long term rather than acute, and by problems of everyday life and relationships with others; the second by the organisation, presentation and form of education and the third by thoughts about the information required, its relevance and implications. CONCLUSIONS: Asthmatic patients' concepts of therapeutic education are poorly defined. There expectations are implicit but they are not fully aware of them. Clarifying these factors will be a way of creating a better basis for an educational programme.

[Therapeutic education of the asthmatic patient: the presentation of the general practitioner]. / L'éducation thérapeutique de l'asthmatique: le discours du médecin généraliste.

INTRODUCTION: Therapeutic education is part of the recommendations for management of asthmatics. The general practitioner (GP) is an essential link in the management and his/her presentation of education plays an important role in how it is received. This study examines the presentation of therapeutic education by GP's. METHODS: 21 GP's took part in a qualitative enquiry bearing on the following themes: "the asthmatic" and "education of the asthmatic patient". The interviews were analysed by the ALCESTE software programme (Analysis of co- occurrent leximes in the wording of a text) which allows the extraction of the major significant structures of a text. RESULTS: It was found that GP's associate therapeutic education with education in general. They evoke self-teaching tools while they retain the group as the most relevant structure. The notions of time and background treatment were separated. The idea of patient autonomy did not appear spontaneously in the discussion even though it is the foundation of the concept. Analysis of the discussion illustrates the gap that exists between the concepts upon which the recommendations are based and presentation of therapeutic education to asthmatics by GP's. CONCLUSION: Training of GP's appears to be an essential condition for the development of therapeutic education.

Participation restrictions in patients with psychiatric and/or cognitive disabilities: preliminary results for an ICF-derived assessment tool.

UNLABELLED: Participation in community life is a major challenge for most people with psychiatric and/or cognitive disabilities. Current assessments of participation lack a theoretical basis. However, the new International Classification of Functioning, Disability and Health (ICF) provides a relevant framework. AIMS: The present study used an ICF-derived assessment tool to activity limitations and participation restrictions in two groups of participants with disabilities linked to schizophrenia or traumatic brain injury respectively. METHODS: Twenty-six items (related to six ICF sections) were selected by reviewing the literature and gathering the clinician's opinions and representatives of patient associations. These items, yielded an ordinal rating of activity limitations, participation restrictions and contextual factors (social support, attitudes and, systems & politics). Special attention was paid to contextual and environmental factors. The final checklist (called the Grid for Measurements of Activity and Participation, G-MAP) was administered to 16 participants with traumatic brain injury (the TBI group) and 15 participants with schizophrenic disorders (the SD group). Psychometric assessments of cognition and, neurobehavioural, psychological and psychosocial functioning were also performed. RESULTS: The internal consistencies for activity limitations (Cronbach's alpha coefficient=0.89) and participation restriction (Cronbach's alpha coefficient=0.89) were satisfactory. We did not observe any significant differences between the two groups in terms of the psychometric test results. The G-MAP scores demonstrated that the two groups were confronted with the same limitations in self care, domestic life, leisure and community life (i.e., the intergroup differences were not statistically significant in Mann-Whitney tests). However, interpersonal relationships and economic and social productivity appeared to be more severely limited in the SD group than in the TBI group. Similarly, participation restrictions in domestic life, interpersonal relationships and economic and social productivity were more severe in the SD group than in the TBI group. CONCLUSION: G-MAP is a useful, feasible, relevant tool for performing a detailed, individualized assessment of participation restrictions in people with psychiatric and/or cognitive disabilities.

Assessment of quality of life in stroke patients with hemiplegia.

UNLABELLED: Stroke is a major public health issue. Even though most hemiplegic stroke patients may obtain a good functional outcome, many remain dissatisfied with their lives. Indeed, quality of life and subjective well-being should be taken into account in any assessment of stroke survival. OBJECTIVE: To assess long-term quality of life in stroke patients (compared with healthy controls) and the corresponding determinants and predictive factors. METHOD: The patient population consisted of 80 of the 217 first-stroke survivors treated between January and June 2005 in the Clinical Neurosciences Department at Bordeaux University Hospital. After a mean follow-up period of 2 years, 24 patients were interviewed in their homes and data from the 56 others were obtained in a telephone interview. Demographic information, clinical status on admission and functional status (as assessed by Barthel Index) and depression (on the ADRS) at the time of the study visit were recorded. Quality of life was assessed by using the Sickness Impact Profile (SIP-65) and Bränholm and Fugl-Meyer's Satisfaction with Life Scale (LiSat 11). The patients' data were compared with those from 149 healthy controls. RESULTS: Life satisfaction and quality of life were significantly impaired in stroke patients, compared with controls. All life domains were impaired. The worst scores were observed for independence and health-related items in the LiSat 11 and the physical and communication items in the SIP-65. Quality of life was strongly correlated with functional independence, the persistence of hemiplegia and depressive mood, which is in agreement with literature findings. Neither gender nor the initial Rankin score had a significant impact on these parameters. DISCUSSION-CONCLUSION: Quality of life at 2 years is significantly impaired in stroke survivors and seems more difficult to predict than functional independence. However, in addition to these objective results, our interviews suggest that receiving adequate social support might be as important to patients as recovering independence.

The large-scale isolation of bryostatin 1 from Bugula neritina following current good manufacturing practices.

A novel process was designed for the large-scale isolation of bryostatin 1 from the bryozoan Bugula neritina L. in order to obtain multigram quantities of highly pure material for formulation studies, preclinical toxicology, and clinical trials in cancer patients. Multigram quantities of bryostatin 1 were obtained from a collection of approximately 10,000 gallons of wet animal. A phorbol dibutyrate (PDBu) receptor binding assay and hplc with photodiode array detection were used for the design, validation, and control of the isolation process.