Quality of life in patients with non-metastatic breast cancer: evolution during follow-up and vulnerability factors.

OBJECTIVE: In women with breast cancer, many disease-related psychosocial factors directly affect quality of life (QoL) during and after treatment. The aims of this prospective study were to evaluate the psychosocial factors affecting QoL and its dimensions, to study their evolution over time, and to determine the factors associated with this evolution. METHODS: Thirty women with non-metastatic breast cancer were asked to complete a number of questionnaires evaluating QoL and its dimensions, symptoms of anxiety and depression, body image, social support, and coping strategies immediately after their diagnosis of breast cancer (T1), at the end of treatment (T2), and 6 months after the end of treatment (T3). RESULTS: Level of education, mastectomy, and hormonotherapy all had an impact on QoL. QoL and its dimensions changed over time. Coping strategies, social support, body image, and symptoms of anxiety and depression were predictive factors for QoL. CONCLUSION: The identification of these predictive factors should help medical teams to identify the patients who are most vulnerable and susceptible to poor QoL. In women with breast cancer, it is essential to identify and treat any changes in patients' need for support in an appropriate manner, both during the course of therapy and particularly during remission.

Quality of life and disease experience in patients with heart failure with reduced ejection fraction in Spain: a mixed-methods study.

OBJECTIVES: To gather insights on the disease experience of patients with heart failure (HF) with reduced ejection fraction (HFrEF), and assess how patients' experiences and narratives related to the disease complement data collected through standardised patient-reported outcome measures (PROMs). Also, to explore new ways of evaluating the burden experienced by patients and caregivers. DESIGN: Observational, descriptive, multicentre, cross-sectional, mixed-methods study. SETTING: Secondary care, patient's homes. PARTICIPANTS: Twenty patients with HFrEF (New York Heart Association (NYHA) classification I-III) aged 38-85 years. MEASURES: PROMs EuroQoL 5D-5L (EQ-5D-5L) and Kansas City Cardiomyopathy Questionnaire and patient interview and observation. RESULTS: A total of 20 patients with HFrEF participated in the study. The patients' mean (SD) age was 72.5 (11.4) years, 65% were male and were classified inNYHA functional classes I (n=4), II (n=7) and III (n=9). The study showed a strong impact of HF in the patients' quality of life (QoL) and disease experience, as revealed by the standardised PROMs (EQ-5D-5L global index=0.64 (0.36); Kansas City Cardiomyopathy Questionnaire total symptom score=71.56 (20.55)) and the in-depth interviews. Patients and caregivers often disagreed describing and evaluating perceived QoL, as patients downplayed their limitations and caregivers overemphasised the poor QoL of the patients. Patients related current QoL to distant life experiences or to critical moments in their disease, such as hospitalisations. Anxiety over the disease progression is apparent in both patients and caregivers, suggesting that caregiver-specific tools should be developed. CONCLUSIONS: PROMs are an effective way of assessing symptoms over the most recent time period. However, especially in chronic diseases such as HFrEF, PROM scores could be complemented with additional tools to gain a better understanding of the patient's status. New PROMs designed to evaluate and compare specific points in the life of the patient could be clinically more useful to assess changes in health status.

Impact of Environmental Conditions on Secondary Organic Aerosol Production from Photosensitized Humic Acid.

Recent studies have shown the potential of the photosensitizer chemistry of humic acid, as a proxy for humic-like substances in atmospheric aerosols, to contribute to secondary organic aerosol mass. The mechanism requires particle-phase humic acid to absorb solar radiation and become photoexcited, then directly or indirectly oxidize a volatile organic compound (VOC), resulting in a lower volatility product in the particle phase. We performed experiments in a photochemical chamber, with aerosol-phase humic acid as the photosensitizer and limonene as the VOC. In the presence of 26 ppb limonene and under atmospherically relevant UV-visible irradiation levels, there is no significant change in particle diameter. Calculations show that SOA production via this pathway is highly sensitive to VOC precursor concentrations. Under the assumption that HULIS is equally or less reactive than the humic acid used in these experiments, the results suggest that the photosensitizer chemistry of HULIS in ambient atmospheric aerosols is unlikely to be a significant source of secondary organic aerosol mass.

[Old age and smoking]. / Vieillesse et tabac.

Elderly people today have seen a radical change in the image of smokers over the last half century. While once it was approved, it is now demonised. Although smoking declines with age, there are still many elderly smokers. The risks and harm of smoking remain, even in old age. An individual choice to start with, smoking becomes a collective issue in a nursing home. Stopping smoking always brings benefits, even after the age of 80.

Caregivers' representations of elders who drink too much alcohol: crossroads between professional home caregivers and hospitals nurses.

Being old or having alcohol use disorders are two unfavorable conditions for receiving help or optimal care. When these two conditions are associated, professionals are even less attracted to work with old alcoholics. To address this issue, from the professionnals perspective, two studies based on research interviews were crossed, one was conducted with 17 professional home caregivers and the other with 29 hospital nurses. A double analysis of the collected speech was manually performed, then computerized by the Alceste® software. This qualitative research, may have indirectly selected the most favorable agents concerned by the issue: those who agreed to answer. Professional home caregivers have negative and demeaning representations of older drinkers (manipulative, nasty, violent...), which generate feelings of powerlessness when faced with them and deleterious identifications. Despite an expressed lack of training and a lack of support for their activities, these agents are able to develop skills in their caregiving interventions, and find professional satisfaction by accompanying them. Nurses also have an initial negative impression of elders misusing alcohol, but these professionals rapidly consider them as less violent and more approachable than younger adults with alcohol use disorder. The exchanges with these old alcoholic patients, often resort to humor, in a possible attempt for proximity, while the same agents report only very few skills to care for elderly alcoholics. Despite all these negative precedents, care is possible and develops itself in daily practice. Beyond initial and spontaneous adverse reactions, while they feel very isolated and little supported in their actions, professional home caregivers as well as nurses, develop daily assistance and care with elders misusing alcohol. The professional home caregivers' expectancy for training and the nurses' expectancy for support could help improve the first approach of these elders and the quality of care offered to them.

Alcoholic abstinence in elderly subjects with misuse of alcohol.

Alcohol use disorder does not disappear with aging, neither the associated induced-suffering. While the prevalence of alcohol use disorder still remains around 10% in the subjects over 65 year old age, and daily encountered by hospital or nursing-home caregivers. Alcohol misuse is often overlooked in elderly people, which then obtain lesser care than younger adults although the care prognosis remains as good as or better than before the age of 65, alcoholic abstinence gets always a place among care offers to elders suffering of alcohol use disorders and dependence. However abstinence is a complex notion gathering various representations or meanings, and induces necessary psychological changes. Alcoholic abstinence seems thus to be feared by families or caregivers, because of lack of knowledge about the addictive dimension of the disorder. On behalf of ultimate freedom, and allowing a last pleasure, alcohol use disorders and its associated suffering can be neglected because abstinence is considered as aggressive and harmful. However, modalities of reduction of alcohol consumption as well as access control or regulated supply of alcoholic beverages, keep having a place in graduate care offers. Beyond the choice of decreasing or suppress drinking alcohol beverages, which only are terms or conditions of improvement, the main point remains the improvement of well-fare, quality of life and elders' health.

Parental contributions and separation anxiety on adolescents' cannabis use: a preliminary study based on French high school students.

BACKGROUND: Separation anxiety (SA) among adolescents remains a very rare diagnosis. According to some authors, behavioral disorders may arise from SA disorders. This study evaluated the relationship between cannabis use and family functioning among adolescent cannabis users. METHOD: Adolescents (n = 336) completed questionnaires about the frequency of their cannabis use, SA symptoms in adult populations, dysfunctional separation-individuation processes in early adolescence, parental types as perceived by the children, and depression symptoms. RESULTS: Adolescent users of cannabis obtained significantly higher scores than adolescent nonusers of cannabis on the Anxiety Separation Adulthood scale (p < .005) and lower scores on the "care" subscale about parents' representations ("mother," p < .01; "father," p < .001). The logistic regression analysis indicated that SA disorders and care significantly encouraged cannabis use. DISCUSSION: Among adolescents, cannabis use is perceived as a solution that reduces the intolerable feelings of SA disorder. If successful separation-individuation allows autonomy, the results indicate that cannabis use hides individuation problems. The use of this substance allows adolescents to express their personality and differentiate themselves from others through marginal behavior.

[Addictive behavior among the elderly]. / Pratiques addictives dans la vieillesse.

Addictive behavior still persists among the elderly, mainly concerning substance abuse, such as alcohol, tobacco or psychotropic drugs and addictive practices such as gambling. Illegal substances or cyber-addictions appear much less often. The environment (place of residence or care) and/or economic factors may influence behavior and practices. The incidence of somatic illness or psychiatric disorders, such as cognitive impairment among the elderly patients, complicates even further the presentation of addictive disorders and their treatment. The age factor does not seem to lessen the suffering felt by the patient and care is required in an equal manner for all ages. Prevention (maintenance of personal autonomy and quality of life throughout the ageing process) plays an essential role along with the offer of care. The lack of scientific data such as the absence of validation for adult care among the elderly, leave wide scope for epidemiological, clinical and theoretical research.