Proportionate universalism intervention is effective for tackling nutritional social gradient in adolescents: the PRALIMAP-INÈS mixed randomised trial.

OBJECTIVE: This study aimed to investigate the effectiveness of proportionate universalism intervention to reduce the slope of the nutritional social gradient in adolescents. STUDY DESIGN: A mixed (experimental and quasi-experimental) multicentre trial. METHODS: Data from 985 adolescents of the PRALIMAP-INÈS trial (North-eastern France, 2012-2015) were analysed. For this, adolescents were split into five social classes according to the Family Affluence Scale: Highly Less Advantaged (H.L.Ad; n = 33), Less Advantaged (L.Ad; n = 155), Intermediate (Int; n = 404), Advantaged (Ad; n = 324) and Highly Advantaged (H.Ad; n = 69). The overweight care management was a standard care for all and a strengthened one adapted to the social class of adolescents. The main outcome was the 1-year change of the body mass index z-score (BMIz) slope. Other nutritional outcomes were BMI, ΔBMIp95 (BMI minus 95th percentile of the WHO reference), %BMIp95 (percent of 95th percentile of the WHO reference), leisure-time sport, consumption of fruits and vegetables and consumption of sugary foods and drinks. RESULTS: The inclusion data confirmed a weight social gradient expressed by a significant BMIz linear regression coefficient (ß = -0.09 [-0.14 to -0.04], P < 0.0001). The higher the social class, the lower the BMIz. The 1-year BMIz linear regression coefficient was -0.07 [-0.12 to -0.02], corresponding to a significant weight social gradient reduction of 23.3% (ß = 0.021 [0.001 to 0.041]; P = 0.04). Consistent results were found for other nutritional outcomes. CONCLUSIONS: PRALIMAP-INÈS shows that proportionate universalism intervention is effective to reduce the adolescents' nutritional social gradient and suggests that equitable health programmes and policies are a realistic goal.

Development and validation of the Flare-OA questionnaire for measuring flare in knee and hip osteoarthritis.

OBJECTIVE: Ability to assess flares in osteoarthritis (OA) of the knee and hip (KHOA) is important in clinical care and research. Using mixed methods, we developed a self-reported instrument measuring flare and assessed its psychometric properties. METHODS: We constructed questionnaire items from semi-structured interviews and a focus group (patients, clinicians) by using a dual-language (English-French) approach. A Delphi consensus method was used to select the most relevant items. Patients with OA from Australia, France and the United States completed the preliminary Flare-OA, HOOS, KOOS and Mini-OAKHQOL questionnaires online. We used a factor analysis and content approach to reduce items and determine structural validity. We tested the resulting questionnaire (score 0-100) for internal consistency, convergent and known-groups validity. RESULTS: Initially, 180 statements were generated and reduced to 33 items in five domains (response 0 = not at all, to 10 = absolutely) by Delphi consensus (50 patients, 116 professionals) and an expert meeting. After 398 patients (mean [SD] age 64 [8.5] years, 70.4% female, 86.7% knee OA) completed the questionnaire, it was reduced to 19 items by factor analysis and a content approach (RMSEA = 0.06; CFI = 0.96; TLI = 0.94). The Cronbach's alpha was >0.9 for the five domains and the whole questionnaire. Correlation coefficients between Flare-OA and other instrument scores were as predicted, supporting construct validity. The difference in Flare-OA score between patients with and without flare (31.8) largely exceeded 2 SEM (10.2). CONCLUSION: Flare-OA is a valid and reliable patient-reported instrument for assessing the occurrence and severity of flare in patients with KHOA in clinical research.

Cognitive rehabilitation in multiple sclerosis.

Cognitive impairments are frequent in multiple sclerosis (MS). However, most studies about efficacy of cognitive rehabilitation interventions have been criticized in terms of methods and/or design. The aim of this study is to evaluate the efficacy of cognitive rehabilitation in MS patients with a cognitive intervention (ProCogSEP* program), compared to a control intervention (discussion program). Twenty MS patients have completed this simple blind study: 10 patients followed 13 sessions (2 hours) of the ProCog-SEP(1) program. Ten other patients followed 13 sessions (2 hours) of a discussion program (Control Group). All patients underwent neuropsychological assessment, before and after their program, in order to evaluate cognitive functions. Two neuropsychologists respectively assessed the patients and conducted the group sessions. Compared to its own baseline, ProCog-SEP Group show improvements in verbal memory [free recall (p = .02), learning (p = .002)], in visual memory [free (p = .05) and delayed recall (p = .007)], in working-memory (p = .03), in verbal fluency (p = .05) and in language (p = .01). Inter group analysis show a benefit of cognitive program mainly in verbal and visual memory, and in verbal fluencies. These results support the interest of a cognitive therapeutic management of MS patients.

Coping strategies as related to medical and demographic data in amyotrophic lateral sclerosis.

INTRODUCTION: The aim of this study was to examine the coping strategies of 49 patients with amyotrophic lateral sclerosis (ALS) and their relationships with medical and demographic data. METHODS: A total of 49 subjects were asked to fill out a document that would provide their demographic and medical data. Then, each one was asked to complete a questionnaire of coping strategies called the Brief COPE. RESULTS: Regarding age groups, we noticed several significant differences concerning emotional support, venting, positive reframing, planning and humour. All these strategies were used significantly more often by younger patients. As for medical variables, the clinical form (bulbar vs spinal ALS), and participation or non-participation in a clinical trial proved to affect the coping style. The correlation analysis showed that disease duration was positively and significantly related to acceptance, positive reframing and humour. Only one significant correlation was observed between coping strategies and ALS Functional Rating Scale (ALSFRS) scores. It concerned blame, which was negatively correlated with ALSFRS scores. DISCUSSION: Our study clearly demonstrated the relationships between coping strategies and medical as well as demographic variables. These results encourage us to develop further investigations to better understand these relationships and to offer better adapted psychological interventions for patients with ALS.

Coping strategies in multiple sclerosis patients with frontal cognitive disorders.

BACKGROUND: Many studies have demonstrated the relationship between multiple sclerosis (MS) and cognition disorder. The objective of this study was to investigate the coping style of patients with mild frontal cognitive disorder. METHODS: 135 patients with MS were divided into two groups as a function of their cognitive states ('mild frontal cognitive impairments' or 'without frontal cognitive impairments'). All were seen for a semi-structured interview in order to collect socio-demographic and clinical information, after which there was an assessment of their cognitive and mental states and fatigue (FAB, MADRS). Then, all patients completed three self-report questionnaires concerning their coping strategies (WCC, CHIP) as well as their fatigue state. RESULTS: No significant differences were observed between the two groups as to coping strategies and mood. However, patients with mild cognitive impairments tended to use more emotion-focused coping strategies, especially self-blame (F(133) = 2.2; p = 0.14) and diversion (F(133) = 1.35; p = 0.24) than patients without cognitive impairments. Patients with mild cognitive impairments were more fatigued than other patients. DISCUSSION: Our study showed that patients with mild cognitive impairments did not differ significantly of other MS patients with regard to coping strategies.

[Evaluation in the interest in arts psychotherapy treatment of alcoholics hospitalized for a weaning process--presentation of two clinical examples]. / Evaluation de l'intérêt de la prise en charge par l'art thérapie de personnes alcooliques hospitalisées pour un sevrage--presentation de deux études de cas.

The aim of our study is to show the relevance of art therapeutic treatment with an alcoholic population met in the weaning department of a general hospital. A current tendency of research in psychology consists in using an integrated quantitative and qualitative methodology. This approach is especially suited to the study of the therapeutic intervention. In arts therapeutic research the investigation of the artistic production and the application of a projective test (Rotter) may complete the psychometric tools: SVF 78 Stressverarbeitungsfragebogen by Janke W., Erdmann G., Kallus W.; MDBF Mehrdimensionalen Befindlichkeitsfragebogens by Steyer R., Schwenkmezger P., Notz P., Eid M.. The results of the study show the relevance of our art therapeutic treatment. We are going to illustrate the multidimensional reality of the therapeutic process by two clinical examples.

Treatment of hypertension in mild asthmatic patients with atenolol.

Fourteen patients with uncomplicated essential hypertension and mild asthma were treated with Atenolol 50-125 mg/day for up to 8 months. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), rate pressure index (RPI), stress testing time (STT) and peak expiratory flow rate (PEFR) were measured before, during and after stress testing (ST) before and during treatment. Atenolol significantly lowered HR, SBP, DBP and RPI. It prolonged STT and had no effect on PEFR. Furthermore, Atenolol did not worsen the patient's asthma except for one patient. The drug did not interfere with the bronchodilatation effect of salbutamol. Atenolol can be used cautiously to treat hypertension in asthmatic patients under certain conditions.

[Multidimensional assessment of coping: validation of the Brief COPE among French population]. / Evaluation multidimensionnelle du coping: validation du Brief COPE sur une population française.

This Article aims to introduce the translation and the validation of a multidimensional measure of coping strategies: the Brief COPE, in a French population. The coping concept comes from psychological studies that were conducted on stress. In the conceptual analysis of stress by Lazarus and Folkman, coping works with two cognitive appraisals performed by the person concerning the perception of a threatening situation and his or her available resources to deal with it. Coping is defined as "cognitive and behavioural efforts to master, reduce, or tolerate the internal and/or external demands that are created by the stressful transaction". The Brief COPE is the abridged version of the COPE inventory and presents fourteen scales all assessing different coping dimensions: 1) active coping, 2) planning, 3) using instrumental support, 4) using emotional support, 5) venting, 6) behavioural disengagement, 7) self-distraction, 8) self-blame, 9) positive reframing, 10) humor, 11) denial, 12) acceptance, 13) religion, and 14) substance use. Each scale contains two items (28 altogether). This inventory has the advantage of being built from acknowledged theoretical models (Lazarus' transactional model of stress, 1984; behavioral self-regulation model, Carver and Scheier, 1981, 1998). It can be used to assess trait coping (the usual way people cope with stress in everyday life) and state coping (the particular way people cope with a specific stressful situation). As is the COPE inventory, the Brief COPE is a measure used for many health-relevant studies: drugs addiction, ageing, breast cancer, depression, AIDS. Both measures are widely used in Anglophone countries and translated in many Languages. Today, the COPE inventory has been validated among Estonian, Croatian, Chinese, and Italian populations and the Brief COPE is also validated among Spanish people. Thus, the worldwide use of this coping inventory should allow a broad comparison of medical and psychological research for coping strategies regarding every kind of pathologies. Thus, we were led to present the translation and the validation of this measure in a French population. Two studies are presented in this Article: the first one describes the validation of the inventory in a dispositional format (trait coping) and the second one the validation of the inventory in a situational format (state coping). The French version of Brief COPE, which was used for both studies, was back-translated and analysed by the Brief COPE Author: Charles S. Carver. For study 1, 834 first Year university students answered the Brief COPE in its dispositional format. To study the factor structure of the Brief COPE, we used structural equation modeling and the LISREL software. Results show that the expected theoretical structure and the observed one fit adequately (c2=606, p<0,05, RMSEA=0,04, GFI>0,95, AGFI>0,92, RMR<0,03). In order to study convergent and discriminant validity of Brief COPE, self-esteem (SEI, Rosenberg, 1979), perceived stress (PSS, Cohen et al., 1983), and psychological distress (GHQ-12, Goldberg, 1972) measures were used. Results show that functional coping strategies (eg, active coping) are linked to good self-esteem, to lower perceived stress, and to lower psychological distress, whereas less functional strategies (eg, denial or self-blame) are widely linked to poor self-esteem, to a high perceived stress, and to psychological distress. Study 1 shows also several significant gender differences. Study 2 describes the Brief COPE validation in its situational format. 178 additional students answered this version. The method that was used is the same the one developed by Lazarus and his colleagues for the WCC validation. Participants were asked to recall and think about the most stressful event they had experienced during the past two Months. They were also to give an account of how much that situation mattered to them. They had to evaluate their capacity to control the situation and indicated whether they felt the situation was amenable to change. The study includes only peoples only people who labeled an event as "important" or "very important". Here again LISREL was used to study the factor structure of the Brief COPE. The results emphasise - as in study 1 - that the expected theoretical structure and the observed one fit adequately (c2=391, p<0,05, RMSEA<0,05, GFI=0,87, AGFI=0,80, RMR<0,06). Differences among means showed how the perceived control of the situation and how the perception of its favourable evolution influenced the coping strategies used (eg, humour or denial). Results in both studies indicate good psychometric properties for the Brief COPE in its French version, whatever the format (ie, dispositional or situational). Thus French searchers have a relevant tool on hand to measure as accurately as possible the coping strategies someone used in everyday life (strategies interfering on health, on a long scale), or in distressful situations (eg, serious illness, traumas). The fact that this easy-to-use coping measure is worldwide spread among medical and psychological studies allows a better broadcast and comparison of results whatever the pathology.