A Tailored Intervention for Improving Diabetes Self-care Among Adults With Visual Impairment: A Pilot Study.

OBJECTIVES: Our aim in this study was to develop and evaluate a tailored intervention for improving diabetes self-care among people with visual impairment (TID-VI) in South Korea. METHODS: The TID-VI program was designed around the barriers, resources, and perceptual factors to promote diabetes self-care in those with visual impairment (VI). A single-arm pilot study was conducted to evaluate the feasibility and preliminary effects of the intervention. Diabetes self-efficacy, self-care behaviours, depression, health-related quality of life, and clinical outcomes (fasting blood glucose, glycated hemoglobin [A1C], lipids, and blood pressure) were measured before, and up to 2 months after the 12-week intervention. RESULTS: All 14 participants completed TID-VI. Diabetes self-efficacy, diabetes self-care behaviours, depression, and health-related quality of life showed improvement from baseline that was sustained at 2 months. Although high- and low-density lipoprotein also improved, there were no differences in blood glucose, A1C, total cholesterol, or blood pressure at 2 months. CONCLUSIONS: A theory-driven, tailored intervention specific to the needs of adults with VI can produce substantial improvements in patient-reported quality of life and health status outcomes, although the benefits are yet to be confirmed in a controlled study.

The mental health of high school students returning to in-class lessons.

OBJECTIVES: It is known that lockdown alters the mental health of children in general and adolescents in particular. Here, we surveyed the mental health of high school students returning to in-class lessons after the pandemic. We compared an "anxious-depressed" group with a "neither anxious nor depressed" group with regard to perceived self-efficacy. METHODS: Students from a high school in the Rhône-Alpes region of France participated in a mental health survey. After the students had been given a study information sheet and had agreed to participate, they filled out three paper-based questionnaires the State-Trait Anxiety Inventory for Children (STAI-C), the Center for Epidemiological Studies-Depression (CES-D) self-questionnaire, and the Self-Efficacy Questionnaire for Children (SEQ-C) on an anonymous basis. RESULTS: A total of 709 datasets were analyzed. The participants' mean±standard deviation age was 15.89±0.93. The group comprised 438 girls, 251 boys, and 20 participants who did not state their sex. Compared with the boys, the girls had significantly higher scores in the STAI-C and CES-D questionnaires. According to the SEQ-C, the boys felt significantly more effective than the girls overall and for social efficacy and emotional efficacy. In contrast, the boys and girls did not differ regarding the academic efficacy score. Our main findings were that 53% (n=379) of the high school students were reportedly free of anxiety or depression, 28% (n=198) showed symptoms of subclinical anxiety and depression, and 19% (n=131) showed symptoms of clinical anxiety or depression. We compared the "anxious-depressed" group with the "neither anxious nor depressed" group: the former group was mainly composed of girls, whereas there were nearly as many boys as girls in the latter group. After adjustment for sex, the overall self-efficacy and the academic, social and emotional efficacy scores were found to be lower in the "anxious-depressed" group. The sex difference was null for social efficacy, small for overall efficacy and academic efficacy, and moderate for emotional efficacy. CONCLUSIONS: Overall, 47% of the study participants reported subclinical anxiety and/or a depression. It appears that anxiety and depression are linked to self-efficacy: the self-efficacy score was lower in the "anxious-depressed" group than in the "neither anxious nor depressed" group.

[Effectiveness of psychotherapy on dissociative symptoms in adult populations: A PRISMA systematic review]. / Efficacité des psychothérapies sur les symptômes dissociatifs en population adulte : une revue de la littérature PRISMA.

INTRODUCTION: Dissociation is a psychological process in reaction to threat which can be found in many psychiatric conditions. Dissociative symptoms can become very disabling, whether in daily life or in care. Nevertheless, few studies seem to have examined the efficacy of psychotherapy on the latter and its relevance as a therapeutic target. METHOD: A systematic review of the literature (PRISMA) on the efficacy of psychotherapy on dissociative symptoms in adults with mental disorders was conducted. Effectiveness was considered in terms of reduction in dissociative symptomatology. The search was conducted on Scopus, PubMed and PsycInfo. Overall, 50 full-text articles were evaluated. RESULTS: Fourteen studies were included in the review. In all, 711 adult subjects with post-traumatic stress disorder, borderline personality disorder or dissociative disorder were included. Overall, this systematic review reports a reduction in dissociative symptoms associated with a variety of psychotherapeutic interventions, without allowing any conclusions to be drawn on the superiority of one psychotherapy over another. DISCUSSION: The conclusions of this work highlight three possible therapeutic orientations for reducing dissociative symptoms: (i) by reintegrating the dynamic subsystems, (ii) by treating the cognitive processes underlying dissociation, and (iii) by acting on the processes identified as common to the effectiveness of psychotherapy.

From co-regulation to self-regulation: Maternal soothing strategies and self-efficacy in relation to maternal reports of infant regulation at 3 and 7 months.

This study, conducted in Germany, examines the role of maternal soothing strategies to explain the association of maternal self-efficacy with infant regulation (crying and sleeping behavior). Questionnaire data of 150 mothers, living in Germany, with mixed ethnic and educational backgrounds were collected when infants were 3 and 7 months old. Two types of maternal soothing strategies were distinguished: close soothing, involving close physical and emotional contact, and distant soothing, involving physical and emotional distancing from the infant. A cross-sectional SEM at 3 months indicated that maternal self-efficacy is associated with reported infant regulation through distant soothing strategies. Low maternal self-efficacy was associated with frequent maternal use of distant soothing, which in turn was related to reported infant regulation problems, that is, non-soothability and greater crying frequency. Frequent use of close soothing was associated with reported infant sleeping behavior, that is, frequent night-time awakenings. A longitudinal SEM further indicated that the effects of close soothing persisted at least until the infants' age of 7 months. The study showed how low maternal self-efficacy, increased use of distant soothing, and reported early infant regulation problems are intertwined and that, due to their persisting positive effect on infant soothability, close soothing better supports infant development.

Este estudio examina el papel de las estrategias calmantes maternas para explicar la asociación entre auto efectividad materna y la regulación del infante (comportamiento de llanto y de dormir). Información de cuestionario de N = 150 madres de trasfondos étnicos y educativos mixtos se recogió cuando los infantes tenían tres y siete meses de nacidos. Dos tipos de estrategias calmantes maternas se identificaron: estrategia calmante cercana, la cual trata del contacto físico y emocional cercano, y estrategia calmante distante, la cual trata del distanciamiento físico y emocional con el infante. Un estudio de Modelo de Ecuación Estructural (SEM) transversal a los tres meses indicó que la auto efectividad materna se asocia con la reportada regulación del infante a través de estrategias calmantes distantes. La baja auto efectividad materna se asoció con el frecuente uso materno de estrategias calmantes distantes, lo cual a su vez se relacionó con los reportados problemas de regulación del infante, tales como el no calmarse y la mayor frecuencia del llanto. El uso frecuente de estrategias calmante cercanas se asoció con el reportado comportamiento de dormir del infante, tal como el frecuente despertar nocturno. Un estudio de tipo SEM longitudinal indicó más allá que los efectos de las estrategias calmantes cercanas persistían por lo menos hasta que los infantes tenían siete meses de edad. El estudio mostró cómo la baja auto efectividad materna, el uso incrementado de estrategias calmantes distantes, así como los reportados tempranos problemas de regulación del infante están entremezclados y que, debido a su persistente efecto positivo en calmar al infante, las estrategias calmantes cercanas apoyan mejor el desarrollo del infante.

Cette étude examine le rôle des stratégies maternelles d'apaisement pour expliquer le lien de l'auto-efficacité maternelle avec la régulation du nourrisson (pleurs et comportement du sommeil). Des données d'une questionnaire de N = 150 mères issues de milieux ethniques et éducationnels différents ont été recueillies quand les nourrissons avaient trois et sept mois. Deux types de stratégies maternelles d'apaisement ont été distingués: l'apaisement proche, avec un contact physique et émotionnel proche, et l'apaisement distant, avec une distanciation physique et émotionnelle du nourrisson. Une coupe transversale SEM à trois mois a indiqué que l'auto-efficacité maternelle est liée à la régulation infantile signalée au travers de stratégies d'apaisement distantes. Une auto-efficacité maternelle faible était liée à l'utilisation maternelle fréquente de stratégies d'apaisement, qui à son tour était liée aux problèmes signalés de régulation du nourrisson, comme par exemple le fait de ne pas pouvoir être apaisé ou une fréquence de pleurs plus grande. L'utilisation fréquente de stratégies d'apaisement proche était liée au comportement de sommeil du nourrisson signalé, comme par exemple des réveils nocturnes fréquents. Un SEM longitudinal a de surcroit indiqué que les effets de stratégies d'apaisement proches persistaient au moins jusqu'à l'âge de sept mois des nourrissons. L'étude a montré comment l'auto-efficacité maternelle faible, une utilisation accrue de stratégies d'apaisement distant et les problèmes signalés de régulation précoce des nourrissons sont imbriqués et que, du fait de leur effet positif persistant sur l'apaisement du nourrisson, les stratégies d'apaisement proches soutiennent mieux le développement du nourrisson.

[Ketamine in chronic pain]. / Intérêt de la kétamine dans le traitement des douleurs chroniques.

Ketamine is now frequently used in the management of chronic pain refractory to conventional treatments. However, its efficacy and adverse effects appear variable in the literature in line with heterogeneous methodologies and modes of administration, leading to controversy regarding the actual interest of ketamine for chronic pain treatment. A need for clinical trials on larger cohorts of well selected patients but also real-life studies to more accurately quantify its efficacy, refine its prescription dosages and better understand its long-term adverse effects is highlighted in the literature. Progress in this direction has been achieved in recent years with improved recommendations for use, taking into account different trajectories of analgesia with ketamine, depending on the etiology of the pain, and the psycho-affective profile of patients. A holistic approach is clearly needed with consideration of pain and depression comorbidities to optimize pain management.

Title: Intérêt de la kétamine dans le traitement des douleurs chroniques. Abstract: La kétamine est aujourd'hui fréquemment utilisée dans la prise en charge de la douleur chronique réfractaire aux traitements classiques. Selon les études, l'efficacité et les effets indésirables de la kétamine apparaissent variables, en lien avec des méthodologies et des modes d'administration hétérogènes, conduisant à des controverses sur son utilisation en clinique. Un besoin d'essais sur des cohortes plus nombreuses de patients mieux sélectionnés mais aussi d'études en « vraie vie ¼ pour mieux quantifier son efficacité, raffiner les posologies de prescription et mieux comprendre ses effets indésirables à long terme, est régulièrement souligné dans la littérature. Toutefois, au cours des dernières années, plusieurs travaux ont permis d'avancer sur les recommandations d'utilisation. Ils soulignent en particulier la nécessité de prendre en compte à la fois les trajectoires diverses d'antalgie avec la kétamine, selon l'étiologie de la douleur, et les comorbidités, en particulier la dépression, afin d'optimiser la prise en charge des patients douloureux.

[Fathers' negative experience of childbirth is associated with an increased risk of paternal postpartum depression]. / L'accouchement vécu négativement par les pères est associé à une augmentation du risque de dépression paternelle en post-partum.

OBJECTIVES: The aim of this study was to investigate the influence of the childbirth experience by primiparous fathers living in France on their level of postnatal depression, parental self-efficacy, and postnatal sense of security. METHODS: Two hundred and fifty men answered sociodemographic questions and filled up the Edinburg Postnatal Depression Scale (EPDS), the First-Time Father Questionnaire (FTFQ), the Parent Expectations Survey (PES) and the Parents' Postnatal Sense of Security Instrument (PPSSi). RESULTS: A negative birth experience was associated with a higher rate of postnatal depressive symptoms (P<.001) and a lower level of postnatal security (P<.001). However, no relationship was found between childbirth experience and sense of parental efficacy (P=0.09). CONCLUSIONS: Similar to mothers, the way fathers experience the birth of their partner can have consequences for the way they go through the postpartum period. In order to prevent possible depressive affects that may impact the relationship with their child, and to strengthen their sense of security when returning home, it is important to provide fathers with appropriate support throughout the perinatal period.

Double scattering and pencil beam scanning Monte Carlo workflows for proton therapy retrospective studies on radiation-induced toxicities.

PURPOSE: Monte Carlo (MC) simulations can be used to accurately simulate dose and linear energy transfers (LET) distributions, thereby allowing for the calculation of the relative biological effectiveness (RBE) of protons. We present hereby the validation and implementation of a workflow for the Monte Carlo modelling of the double scattered and pencil beam scanning proton beamlines at our institution. METHODS: The TOPAS/Geant4 MC model of the clinical nozzle has been comprehensively validated against measurements. The validation also included a comparison between simulated clinical treatment plans for four representative patients and the clinical treatment planning system (TPS). Moreover, an in-house tool implemented in Python was tested to assess the variable RBE-weighted dose in proton plans, which was illustrated for a patient case with a developing radiation-induced toxicity. RESULTS: The simulated range and modulation width closely matches the measurements. Gamma-indexes (3%/3mm 3D), which compare the TPS and MC computations, showed a passing rate superior to 98%. The calculated RBE-weighted dose presented a slight increase at the necrosis location, within the PTV margins. This indicates the need for reporting on the physical and biological effects of irradiation in high dose regions, especially at the healthy tissues and increased LET distributions location. CONCLUSION: The results demonstrate that the Monte Carlo method can be used to independently validate a TPS calculation, and to estimate LET distributions. The features of the in-house tool can be used to correlate LET and RBE-weighted dose distributions with the incidence of radiation-induced toxicities following proton therapy treatments.

Long-term efficacy and tolerance of a technique for postmastectomy electron beam radiation therapy of the unreconstructed chest wall and lymph node areas for non-metastatic breast cancers.

PURPOSE: To evaluate the long-term tolerance and outcome of patients irradiated with an electron beam technique used since 2007 on the chest wall and lymph node areas after mastectomy for non-metastatic locally advanced breast carcinoma. PATIENTS AND METHODS: All patients irradiated with an improved electron beam technique after mastectomy for non-metastatic breast carcinoma between 2007 and 2011 at Institut Curie (France) were included in this descriptive study. The technique has already been described in other studies, as has its 5-year tolerance and non-inferiority compared to photon irradiation. Acute and chronic toxicity were collected using CTCAE v 3.0. A clinical examination was carried out each week during the radiotherapy and at each 6 months consultation with one mammogram per year at the Institut Curie for at least 5 years. The patients then continued to be followed either at the Institut Curie or in private practice with a good transmission of outpatient consultations, thanks to a system of forms to be completed and integrated into the electronic files. Quantitative and qualitative data are defined by mean and proportion. Statistical comparisons were made by computer using the Chi2 test and Fisher's exact test for categorical variables. Recurrence-free survival was defined as the time between the end of treatment and the date of recurrence or death. Overall survival was defined in the same way without taking into account recurrences. Patients who did not report any events were censored at the date of last news. RESULTS: Of the 796 patients included, 51.3% had multifocal lesions, 10.1% had triple negative status, and 18.8% displayed overexpression of the Her2 receptor, 196 (24.6%) patients received neoadjuvant chemotherapy and 208 (26.1%) systemic treatment during radiotherapy (chemotherapy or targeted therapy); 514 (64.6%) had at least one positive lymph node. The internal mammary chain (IMC) was irradiated in 85.6% of cases, the supraclavicular areas in 88.3% of cases, the infraclavicular in 77.9% of cases and the axillary area in 14.9% of cases. With a median follow-up of 113 months (range: 2-164 months), locoregional recurrence-free survival and overall 10-year survival was respectively 94.02%, (95% CI: 92.13-98.94) and 79.84% (95% CI: 76.83-82.97). Median survival was not reached. In the long term, 29.6% of patients had telangiectasias (grade 1: 23.3%, grade 2: 5.2%, grade 3: 1.1%). There were 279 patients (35.1%) with secondary breast reconstruction on average 21 months after all treatments. IMC irradiation was not associated with a majority of pulmonary toxicity. Thirty-five patients developed chronic heart disease after radiotherapy, 30 of whom had received anthracyclines and 9 had received traztuzumab. Three of these reported a coronary ischaemic event, including 2 irradiated on the left and 1 on the right, the 4 were irradiated in the vicinity of the IMC and the other lymph node areas, but presented many other cardiovascular risk factors (between 2 and 4). During follow-up, 4.9% of patients had a contralateral recurrence (n=39) and 5.5% had a second non-breast cancer (n=44), of the 6 bronchopulmonary cancers diagnosed, none appeared to be related to chest wall radiotherapy. CONCLUSION: This study confirms that the improved postmastectomy electron beam radiation therapy technique is well-tolerated after nearly 10 years of follow-up.

[Physical activity and lung cancer: A synthesis of the literature]. / Activité physique et cancer broncho-pulmonaire : Synthèse de la littérature.

INTRODUCTION: Physical activity (PA) has its place in the continuum of care, the objective being to limit alterations associated with cancer and its treatments. This review of the literature collates the evidence and current data relating to PA carried out at different periods of treatment for lung cancer. STATE OF THE ART: PA is safe and feasible in patients with lung cancer throughout their oncologic treatment. The efficacy of multimodal programs is demonstrated regarding symptoms, exercise capacity, functional capacity, postoperative complications, length of hospital stay and quality of life. Nevertheless, this result remains to be confirmed with more robust upcoming trial, notably in the long term. PERSPECTIVES: Utilization of activity and energy expenditure sensors or PA questionnaires could help to increase the PA level of lung cancer patients during their continuum of care. For those not at ease with conventional training modalities, it may be judicious to offer intermittent high-intensity training or respiratory muscle strength training. Telerehabilitation could also be implemented. The targeting of populations at high risk should be investigated. CONCLUSION: Teams caring for patients with lung cancer during or after their oncologic treatment should develop innovative strategies designed to overcome difficulties of access or adherence to exercise programs, so that the PA be an integral part of the care of these patients. Physical therapists play an important role in supporting these patients during their assessment or treatment.

Mothering from the Inside Out: Results of a community-based randomized efficacy trial testing a mentalization-based parenting intervention for mothers with addictions.

Mothering from the Inside Out (MIO) is a mentalization-based parenting intervention developed to address challenges common among mothers experiencing substance use disorders (SUDs) and previously deemed effective when delivered by research clinicians. This randomized clinical trial was designed to test the efficacy of MIO when delivered by community-based addiction counselors in Connecticut, USA. Ninety-four mothers [M(SD)age = 31.01(4.01) years; 75.53% White] caring for a child 11-60 months of age were randomly assigned to participate in 12 sessions of either MIO or psychoeducation. Caregiving, psychiatric, and substance use outcomes were assessed repeatedly from baseline through 12-week follow-up. Mothers who participated in MIO showed decreased certainty about their child's mental states, and decreased depression; their children demonstrated increased clarity of cues. Participation in MIO was not associated with the same degree of improvement that was observed in prior trials where MIO was delivered by research clinicians. However, when delivered by community-based clinicians, MIO may be protective against a deterioration in caregiving over time often seen in mothers with addictions. The drop in efficacy of MIO in this trial raises questions about intervention-intervenor fit. Research should examine factors influencing MIO effectiveness to close the science-to-service gap common in the dissemination of empirically validated interventions.

Cuidados Maternales desde Dentro (MIO) es una intervención de crianza con base en la mentalización desarrollada para discutir los retos que son comunes entre las madres que experimentan trastornos de uso de sustancias (SUD) y que previamente eran considerados eficaces cuando los ofrecían los investigadores clínicos. Este ensayo clínico al azar se diseñó para examinar la efectividad de MIO cuando la ofrecen consejeros en asuntos de adicción con base en la comunidad, en Connecticut, Estados Unidos. Noventa y cuatro madres [M(SD) edad = 31.01(4.01) años; 75.53% blancas] con un niño de 11 a 60 meses de edad bajo su cuidado fueron asignadas al azar para participar en 12 sesiones, ya sea de MIO o de psicoeducación. Los resultados del cuidado prestado, los siquiátricos y los de uso de sustancia se evaluaron repetidamente a partir de los datos básicos hasta el seguimiento a las 12 semanas. Las madres que participaron en MIO mostraron una disminución en la certeza acerca de los estados mentales de sus niños, y una disminución en la depresión; sus niños demostraron un aumento en la claridad de las señales. La participación en MIO no se asoció con el mismo grado de mejoramiento que se observó en ensayos previos en los que MIO fue ofrecido por investigadores clínicos. Sin embargo, cuando es ofrecido por clínicos con base comunitaria, MIO pudiera servir de protección contra el deterioro de la prestación de cuidado a lo largo del tiempo, a menudo visto en madres con adicciones. La disminución de la efectividad de MIO en este ensayo genera preguntas acerca de cuán compenetrados está el interventor con la intervención. La investigación debe examinar factores que influyan en la efectividad de MIO para cerrar el vacío entre servicio y ciencia, común en la diseminación de las intervenciones empíricamente validadas.

Le maternage de l'intérieur (abrégé ici MIO pour reprendre l'anglais Mothering from the Inside Out) est une intervention de parentage basée sur la mentalisation, développée afin de répondre aux défis courants chez les mères ayant un trouble lié à l'usage d'une substance (TUS) et préalablement considérée comme efficace lorsque faite par des chercheurs cliniques. Cette étude clinique randomisée a été conçue pour tester l'efficacité du MIO lorsque offert par des intervenants en dépendance communautaires dans l'état du Connecticut aux Etats-Unis. Quatre-vingt-dix-neuf mères [M(SD)âge = 31,01(4,01) ans; 75,53% blanches] prenant soin d'un enfant de 11-60 mois ont été réparties au hasard pour participer soit au MIO soit à une psychoéducation. Les résultats de soins, les résultats psychiatriques et les résultats de toxicomanie ont été évalués de façon répétée de la base jusqu'au suivi à 12 semaines. Les mères ayant participé au MIO ont fait preuve d'une certitude diminuée à propos des états mentaux de leur enfant, et d'une dépression diminuée; leurs enfants ont fait preuve d'une clarté des indices accrue. La participation au MIO n'était pas liée au même degré d'amélioration qui a été observé dans les études préalables quand le MIO a été utilisé par des chercheurs cliniciens. Cependant, lorsqu'administré par des cliniciens communautaires, le MIO pourrait s'avérer protecteur d'une détérioration dans les soins au fil du temps que l'on voit souvent chez les mères toxicomanes. Le déclin d'efficacité du MIO dans cette étude soulève des questions quant à l'ajustement intervention-intervenant. Les recherches devraient se pencher sur les facteurs influençant l'efficacité du MIO pour réduire l'écart de la science au service dans la dissémination d'intervention validées empiriquement.

Safety and efficacy of immunotherapy according to the age threshold of 80 years.

BACKGROUND: To compare safety and efficacy of ICIs among patients<80 and those ≥80 years of age. METHODS: A single-center retrospective observational cohort study comparing patients<80 and ≥80 years of age matched for cancer site (lung vs others) and participation in a clinical trial. PRIMARY ENDPOINT: grade ≥2 toxicity during the first three months of ICI therapy. The two groups were compared using univariate and multivariate regression. RESULTS: Two hundred and ten consecutive patients were recruited, with the following characteristics: mean age: 66.5±16.8, 20% aged ≥80 years, 75% male, 97% ECOG-PS ≤ 2, 78% G8-index ≤ 14/17, 80% lung or kidney cancer, and 97% metastatic cancer. The grade ≥2 toxicity rate during the first three months of ICI therapy was 68%. Patients aged ≥80 years of age had a more significant (P<0.05) proportion of grade ≥2 non-hematological toxicities (64% vs 45%) than those aged<80 years: rash (14% vs 4%), arthralgia (7.1% vs 0.6%), colitis (4.7% vs 0.6%), cytolysis (7.1% vs 1.2%), gastrointestinal bleeding (2.4% vs 0%), onycholysis (2.4% vs 0%), oral mucositis (2.4% vs 0%), psoriasis (2.4% vs 0%), or other skin toxicities (25% vs 3%). Efficacy among patients ≥80 and<80 years of age was comparable. CONCLUSIONS: Although non-hematological toxicities affected 20% more patients aged ≥80 years, hematological toxicities and efficacy were comparable between patients aged ≥80 and<80 years with advanced cancer and treated with ICIs.

Maternal self-efficacy development from pregnancy to 3 months after birth.

The present study uses a prospective longitudinal study design to investigate the development of maternal self-efficacy in the transition phase to parenthood, drawing on a large sample of socially and/or culturally disadvantaged families (N = 292). Parity, maternal education, migration, informal and formal social support are considered as potential predictors. Results indicate that previous birth experience, being born abroad, and higher levels of formal and informal social support during pregnancy jointly predict higher levels of maternal self-efficacy three months after birth. First-time mothers and mothers born in Germany (where the study was conducted) benefit more from formal support than mothers with previous experience and mothers born outside of Germany. Overall, maternal self-efficacy increases significantly. Implications for prenatal maternal care are discussed.

El presente estudio usa un diseño de estudio longitudinal potencial para investigar el desarrollo de la auto efectividad materna en la fase de transición a ser madre. Usando una muestra grande de familias desfavorecidas social y/o culturalmente (N = 292). Se consideran como potenciales factores de predicción la paridad, la educación materna, la migración, y el apoyo social informal y formal. Los resultados indican que una previa experiencia de dar a luz, el haber nacido en el extranjero, así como altos niveles de apoyo social formal e informal durante el embarazo predicen en conjunto altos niveles de auto efectividad materna tres meses después del parto. Las madres primerizas y las madres nacidas en Alemania (donde se llevó a cabo el estudio) se beneficiaron más del apoyo formal que las madres con experiencia previa y las madres nacidas fuera de Alemania. En general, la auto efectividad materna aumentó significativamente. Se discuten las implicaciones para el cuidado materno prenatal.

Cette étude utilise un plan d'étude prospectif longitudinal pour se pencher sur le développement de l'auto-efficacité maternelle dans la phase de transition à la parenté, en utilisant un grand échantillon de familles socialement et/ou culturellement défavorisées (n = 292). La parité, l'éducation maternelle, la migration, le soutien social informel et formel sont considérés comme des prédicteurs potentiels. Les résultats indiquent qu'une expérience de la naissance antérieure, le fait d'être née à l'étranger et des hauts niveaux de soutien social formel et informel durant la grossesse prédisent ensemble des niveaux élevés d'auto-efficacité maternelle après la naissance. Les mères étant mères pour la première fois et les mères nées en Allemagne (où l'étude a été faite) ont plus bénéficié d'un soutien formel que les mères ayant déjà donné naissance à un enfant et que les mères nées en dehors de l'Allemagne. Dans l'ensemble l'auto-efficacité maternelle a augmenté de manière importante. Les implications pour le soin maternel prénatal sont discutées.

Preventing early harsh parenting and toddler behavior problems: The role of neighborhood collective efficacy among low-income Latine families.

Harsh parenting behaviors are alarmingly prevalent during infancy and toddlerhood. From an ecological perspective, predicting and preventing harsh parenting requires probing not only micro- and exosystem-level processes but also the interactions among them. In the current longitudinal study, we examined associations among maternal depressive symptoms, harsh parenting, and neighborhood collective efficacy in 142 low-income Latina mothers and their infants (Mchild age = 14.11 months, SD = 3.60). We hypothesized that there would be a mediated pathway from maternal depressive symptoms to harsh parenting to toddler behavior problems, and that neighborhood collective efficacy would moderate this pathway. As predicted, maternal depressive symptoms predicted toddler behavior problems, and harsh parenting significantly mediated this association. Moreover, neighborhood collective efficacy was a significant moderator such that this indirect pathway was maintained in the context of low neighborhood collective efficacy only. When collective efficacy was high, this pathway was not significant. Results are discussed in terms of the buffering potential of neighborhood collective efficacy. Tentative implications for leveraging neighborhood supports to prevent early harsh parenting are suggested.

Las duras conductas de crianza son alarmantemente prevalentes durante la infancia y la primera etapa de la niñez. Desde una perspectiva ecológica, predecir y prevenir la dura crianza requiere investigar no sólo los procesos de micro niveles y niveles de exosistemas, sino también las interacciones entre ellos. En el presente estudio longitudinal, examinamos las asociaciones entre los síntomas depresivos maternos, la dura crianza y la colectiva efectividad del vecindario en 142 mujeres latinas de bajos recursos económicos y sus infantes (M edad del niño = 14.11 meses, SD = 3.60). Nuestra hipótesis fue que habría un camino mediador entre los síntomas depresivos maternos y la dura crianza y los problemas de conducta del pequeño infante, y que la efectividad colectiva del vecindario moderaría este camino. Tal como se predijo, los síntomas depresivos maternos predijeron los problemas de conducta de los pequeños infantes, y la dura crianza significativamente medió esta asociación. Es más, la efectividad colectiva del vecindario fue un moderador significativo, de tal manera que este indirecto camino se mantuvo sólo dentro del contexto de la baja efectividad colectiva del vecindario. Cuando la efectividad colectiva fue alta, este camino no fue significativo. Los resultados se discuten en términos de la potencialidad amortiguadora de la efectividad colectiva del vecindario. Se sugieren tentativas implicaciones para la nivelación de los apoyos del vecindario para prevenir una temprana dura crianza.

Des comportements de parentage durs sont extrêmement prévalents durant la petite enfance (bébés et jeunes enfants). D'une perspective écologique, prédire et prévenir le parentage dur exige un examen non seulement des processus au niveau du microsystème et de l'exosystème mais aussi des interactions entre ces systèmes. Dans cette étude longitudinale nous avons examiné les liens entre les symptômes dépressifs maternels, le parentage dure et l'efficacité collective du voisinage chez 142 mères hispaniques ayant de faibles revenus et leurs bébés (M âge de l'enfant = 14,11 mois, SD = 3,60). Nous avons pris comme hypothèse qu'il y aurait une voie de médiation des symptômes dépressifs maternels au parentage dur et aux problèmes de comportement du petit enfant, et que l'efficacité collective du voisinage modérerait cette voie. Comme on l'avait prédit les symptômes dépressifs maternels ont prédit les problèmes de comportement du petit enfant, et le parentage dur a médiatisé ce lien. De plus, l'efficacité collective du voisinage s'est avéré être un modérateur important, à un tel point que cette voie indirecte était maintenue dans le contexte d'une efficacité collective de voisinage même faible. Quand l'efficacité collective était élevée cette voie n'était pas importante. Les résultats sont discutés en termes de potentiel de mise en tampon de l'efficacité collective du voisinage. De possibles implications pour tirer partie des soutiens des voisinages afin de prévenir un parentage dur précoce sont suggérées.

[Impact of IMRT for neoadjuvant rectal cancer?] / Quel apport de la modulation d'intensité pour la radiothérapie des cancers du rectum ?

The standard management of locally advanced rectal tumors as cT3-T4 and/or N0/N1 is based on preoperative treatment combining radiotherapy of 45 to 50Gy and chemotherapy based on 5-fluorouracil. Intensity-modulated radiotherapy has already shown its interest compared to conformal radiotherapy in other locations, like in pelvic cancer. The role of intensity-modulated radiotherapy in the pre/postoperative treatment of rectal cancers is not a standard of care. Published studies showed its feasibility with the objective of less toxicity with equivalent efficacy.

[Interprofessional Training for Discharge Planning: Effects of Self-Efficacy in Nursing and Medical Students]. / Interprofessionelle Schulung für die Spital-Austrittsplanung: Effekte der Selbstwirksamkeit bei Pflege- und Medizinstudierenden.

Interprofessional Training for Discharge Planning: Effects of Self-Efficacy in Nursing and Medical Students Abstract. Concordant and methodical briefing about a patient's disposition for discharge from hospital within the interprofessional ward round can facilitate a timely discharge. However, interprofessional ward rounds require not only professional skills but also knowledge of interprofessional cooperation between all the occupational groups involved. The question arose whether students of the various professions could learn the necessary competencies during their studies. To this end, a training course on interprofessional discharge planning was developed for nursing and medical students. The training includes four phases consisting of flipped classroom and interprofessional skills training. After each phase, a questionnaire was distributed to assess the self-efficacy of participating nursing and medical students regarding their interprofessional collaboration skills. The results showed that self-efficacy increased steadily with increasing study duration from phase 1 to 4. The study also shows that despite the differences between nursing and medical school curricula, students' self-efficacy regarding interprofessional collaboration skills increased during the IAVI training, which strongly suggests that they benefited from the training.

[Immuno-radiotherapy: A review of the rationale, recent clinical developments and future prospects]. / Immuno-radiothérapie : une revue du rationnel, développements cliniques récents et perspectives futures.

Thanks to the success of checkpoint inhibitors, immunotherapy now plays a major role in the management of a large number of solid tumors, while the number of indications continues to grow and new combinations could, in the near future, further modify treatment standards. However, the response rates of immunotherapies as monotherapy are modest and their use is increasingly considered in combination with other cancer treatments (chemotherapy, surgery, radiotherapy or certain targeted therapies). Combinations with radiotherapy seem particularly attractive because there is a strong experimental rationale linking part of the efficacy of ionizing radiation to an induced stimulation of both of the innate and adaptive response. Many early phases and a number of large randomized combination trials have published efficacy and safety results, while important trials are still ongoing and will provide answers in the near future. This short review recalls the experimental biological rationale for immuno-radiotherapy and highlights some of the fundamental directions being explored, then presents the clinical efficacy and safety results available to date, those expected in the near future, and finally outlines the outlook in this rapidly evolving field.

Adverse childhood experiences and maternal self-efficacy: Examining the mediating role of intimate partner violence and the moderating role of caste membership in rural India.

Maternal self-efficacy (MSE) is associated with healthy functioning in mothers and children globally. Maternal exposure to adverse childhood experiences (ACEs) and intimate partner violence (IPV) is known to negatively impact MSE in high-income countries; however, the association has not been examined in low-and-middle-income countries, such as India, which face socioeconomic risks including poverty, illiteracy, and discrimination based on caste membership. The present study examines the mediating role of IPV in the association between ACEs (specifically-emotional, physical, and sexual abuse, neglect, household dysfunction, and discrimination) and MSE and tests caste membership as a moderator. A community-based, cross-sectional survey was performed with 316 mothers with at least one child between 0 and 24 months in a rural area in the North Indian state of Uttar Pradesh. A structural equation framework was used to test the moderated-mediation model. Results from the moderated-mediation model indicate that greater ACEs exposure was associated with lower MSE and this association was mediated by IPV exposure for low-caste but not high-caste mothers, even after controlling for wealth and literacy. These findings add to existing evidence on ACEs exposure as a significant burden for rural Indian mothers, negatively impacting parenting outcomes such as MSE. The critical role of caste membership is also highlighted, providing implications for future research.

La autoeficacia materna (MSE) se asocia con el saludable funcionamiento en las madres y niños globalmente. Se conoce que el hecho de que la madre haya estado expuesta a experiencias adversas en la niñez (ACE) y a la violencia de la pareja íntima (IPV) tiene un negativo impacto en MSE en países de altas entradas económicas; sin embargo, esta asociación no se ha examinado en países donde las entradas económicas son bajas o medias, como India, que enfrenta riesgos socioeconómicos entre los que se incluyen la pobreza, el analfabetismo, así como la discriminación basada en la pertenencia a una casta. El presente estudio examina el papel mediador de IPV en la asociación entre ACE (específicamente - el abuso emocional, físico y sexual, negligencia, disfuncionalidad en el hogar y discriminación) y MSE, y pone a prueba la pertenencia a una casta como aspecto moderador. Se llevó a cabo una encuesta de base comunitaria e inter-seccional con 316 madres con por lo menos un niño entre 0 y 24 meses de edad en un área rural en el estado de Uttar Pradesh en el norte de India. Se usó un marco de trabajo de ecuación estructural para examinar el modelo de moderación y mediación. Los resultados del modelo de moderación y mediación indican que una mayor exposición a ACE estaba asociada con una más baja MSE y que la exposición a IPV mediaba esa asociación para madres de castas bajas, pero no para madres de castas altas, aun después del factor control de recursos económicos y alfabetismo. Estos resultados contribuyen a la existente evidencia de que el haber estado expuesta a ACE es una carga significativa para las madres en la India rural, la cual tiene un impacto negativo en los resultados de crianza tales como MSE. También se subraya el papel esencial de la pertenencia a una casta, lo cual aporta implicaciones para la investigación futura.

L'auto-efficacité maternelle (MSE en anglais) est globalement liée à un fonctionnement sain chez les mères et les enfants. L'exposition maternelle à des expériences de l'enfance adverses (ACE en anglais) et à la violence intime ou conjugale (IPV) est connue comme impactant de manière négative l'auto-efficacité maternelle dans les pays à revenus élevés. Cependant ce lien n'a pas toujours été examiné dans les pays à faibles ou moyens revenus, tels que l'Inde qui fait face à des risques socioéconomiques qui comportent la pauvreté, l'illettrisme, la discrimination en fonction de l'appartenance à une caste. Cette étude examine le rôle médiateur de la violence conjugale (ou violence entre partenaires intimes) dans le lien entre les ACE (plus spécifiquement l'abus émotionnel, physiques, sexuel, la négligence, la dysfonction au sein du foyer et la discrimination) et l'auto-efficacité maternelle et les tests d'appartenance à une caste en tant que modérateurs. Un questionnaire communautaire, en coupe transversale, a été présenté à 116 mères ayant au moins un enfant entre l'âge de 0-24 mois dans une région rurale de l'état du nord de l'Inde, Uttar Pradesh. Un cadre d'équation structurelle a été utilisé pour tester le modèle de modération-médiation. Les résultats de ce modèle de modération-médiation indiquent que plus l'exposition aux ACE est grande, plus l'auto-efficacité maternelle est basse et cette association est affectée par l'exposition à la violence conjugale pour les castes moins élevées mais pas pour les mères des castes plus élevées, même en effectuant un contrôle pour la richesse et l'alphabétisation. Ces résultats s'ajoutent aux preuves existantes sur l'exposition aux ACE en tant que poids important pour les mères indienne de milieux ruraux, ce qui impacte de manière négative les résultats de parentage telles que l'auto-efficacité maternelle. Le rôle critique de l'appartenance à une caste est également mis en lumière, offrant des implications pour les recherches à venir.

Perceptions and Correlates of Distress Due to the COVID-19 Pandemic and Stress Management Strategies Among Adults With Diabetes: A Mixed-Methods Study.

BACKGROUND: Greater risk of adverse health outcomes and public health measures have increased distress among people with diabetes during the coronavirus-2019 (COVID-19) pandemic. The objectives of this study were to explore how the experiences of people with diabetes during the COVID-19 pandemic differ according to sociodemographic characteristics and identify diabetes-related psychosocial correlates of COVID distress. METHODS: Patients with type 1 or 2 diabetes were recruited from clinics and community health centres in Toronto, Ontario, as well as patient networks. Participants were interviewed to explore the experiences of people with diabetes with varied sociodemographic and clinical identities, with respect to wellness (physical, emotional, social, financial, occupational), level of stress and management strategies. Multiple linear regression was used to assess the relationships between diabetes distress, diabetes self-efficacy and resilient coping with COVID distress. RESULTS: Interviews revealed that specific aspects of psychosocial wellness affected by the pandemic, and stress and illness management strategies utilized by people with diabetes differed based on socioeconomic status, gender, type of diabetes and race. Resilient coping (ß=-0.0517; 95% confidence interval [CI], -0.0918 to -0.0116; p=0.012), diabetes distress (ß=0.0260; 95% CI, 0.0149 to 0.0371; p<0.0001) and diabetes self-efficacy (ß=-0.0184; 95% CI, -0.0316 to -0.0052; p=0.007) were significantly associated with COVID distress. CONCLUSIONS: Certain subgroups of people with diabetes have experienced a disproportionate amount of COVID distress. Assessing correlates of COVID distress among people with diabetes will help inform interventions such as diabetes self-management education to address the psychosocial distress caused by the pandemic.

Long-term follow-up results of intensity-modulated radiotherapy with helicoïdal tomotherapy for non-metastatic breast cancers: Single centre experience.

PURPOSE: Intensity-modulated radiotherapy with helical Tomotherapy is a novel radiation therapy technique, which may be beneficial in several features compared to traditional methods. Our aim was to evaluate the local control, overall survival, progression free survival and adverse events in breast cancer patients treated with this new technique. MATERIAL AND METHODS: This is retrospective analysis of patients irradiated with intensity-modulated radiotherapy with helical Tomotherapy. Overall survival and progression free survival curves were plotted with Kaplan-Meier method. We also analysed the overall survival and progression-free survival data by molecular subgroups. Long-term toxicity including skin, cardiac and pulmonary complications were also evaluated. Multivariant logistic regression analysis was performed to determine the predictors of the side effects. RESULTS: Between 2009-2015, 179 consecutive patients with 194 treated breasts were irradiated with intensity-modulated radiotherapy with helical Tomotherapy. The median follow-up were 65 months. The overall survival rate was 89.2% (95% confidence interval [95CI]: 83.5-95.4%), while disease-free survival rate was 85.4% (95CI: 80.2-91%). The Human epidermal growth factor receptor 2-positive patients had the best 5-year overall survival data of 95% (95CI: 85.9-100%). Long-term skin toxicity was the most common, seen in a total of 20.7% of the patients. CONCLUSION: Intensity-modulated radiotherapy with helical Tomotherapy could be safely used for adjuvant breast cancer irradiation in patients with complex anatomy and provides favourable long-term prognosis with acceptable late toxicity.

[Voiding dysfunction after TVT: A 20-year experience TVT-placement under local anesthesia and sedation]. / Troubles mictionnelles après pose de TVT : 20 ans d'expérience de pose sous diazanalgésie et anesthésie locale.

BACKGROUND: Trans-vaginal tape has become the gold standard for the cure of urinary stress incontinence, but post-operative voiding dysfunction is frequently reported. The purpose of this study is to assess the incidence of voiding dysfunction, dysuria, chronic urinary retention, and necessity of reoperation after retropubic TVT placement under local anaesthesia and sedation. MATERIAL AND METHOD: We perform a retrospective study of a cohort of patient treated with the placement of a retropubic TVT under local anaesthesia and sedation between 1999 and 2019 for a SUI. Post-operative voiding dysfunction and necessity of reoperation were reviewed to access the principal aim of this study. RESULTS: Three hundred and two patients who met the eligibility criteria were included in the study. At 3 months, the dysuria rate and chronic urinary retention rate was 4.3% and 1%. At 12 months it was 2.6% and 0.3% respectively. The 12-month sling section rate was 1% and long-term self-catherization rate was 0.3%. The objective cure rate was 93% and subjective cure was 92%. CONCLUSION: TVT placement under local anaesthesia and sedation resulted in few voiding dysfunctions at medium/long-term, necessity of re-operation for refractory obstructive disorder and well functional results. Even if these results support more frequent use of this type of anaesthesia, it would be interesting to be able to follow them in a prospective study to conclude. LEVEL OF EVIDENCE: 4.